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Managing the pain of new drug warnings

Last week's announcement by the Food and Drug Administration that it plans to strengthen the warnings on common over-the-counter pain pills should have people who use the pills thinking twice about their risks.

Acetaminophen and nonsteroidal anti-inflammatory medications such as aspirin and ibuprofen -- known as NSAIDs and sold under labels like Motrin, Advil, Tylenol and Aleve -- are used to treat headaches, fever and pain. They will all get new labels within the next year warning of possible gastrointestinal and kidney damage, with an increased danger to people who are over 60, have ulcers, take blood-thinning drugs or take them for a long time. Acetaminophen (Tylenol) labels will also warn that overdoses, use with alcohol or over the long term, can cause serious liver damage or death.

But what's a person with a sprain or strain, a pounding headache or even monthly cramps to do?

Local health professionals say that a brief course of over-the-counter pain pills is still probably OK depending on your age and risk factors. But if you're trying to manage long-term pain, discussing it with your doctor is essential.

The problem, according to Dr. David Hartman of Amherst Medical Associates, is that most people don't even mention to their physician the over-the-counter pills they take.

"We have to specifically ask them," he says. "People don't consider them medications."

Any person contemplating taking pain pills "should call their physician to find out what is the safe amount for them," says Hartman. Such factors as age, high blood pressure, heart disease, kidney disease, and what other medications a person takes must be considered.

There is one exception: Hartman says people who take low-dose aspirin once a day shouldn't worry about it. "If it's 81 milligrams, that's not an issue," he says. "But if you start adding to that, that's different."

Any pain, even if you've decided that it's likely to be the same arthritis your grandparents had, should be evaluated by a physician, says Dr. John Fudyma, medical director of Erie County Medical Center. People who self-medicate with over-the-counter pills "don't understand what is causing their pain," he says, "and ideally, they should find the cause of the pain before they cover up a symptom."

Thinking of these medications as always benign is a particular problem for the elderly, Fudyma says. "As we all age, these medicines become even more dangerous for us, and the more medicines we're on, the more interactions we potentially can have by adding over-the-counter medications to our prescription medications."

There are other people, no matter what their age, who "probably shouldn't be taking these" because of underlying health issues, Fudyma says. "Someone with heart disease, for example, if their doctors aren't aware that they are taking Ibuprofin or Aleve, they might not be able to figure out why their patient's blood pressure is so high or why they are always going into congestive heart failure."

A woman who takes pain medications monthly to cope with menstrual cramps might be OK if she has no other underlying health issues, but again: "Tell your doctor what you're doing," says Fudyma. "There may be other pain medications out there that potentially could be safer," he says.

"Or ask your pharmacist if it's safe to take these medicines with your current medicines, including over-the-counter medications. Use your health-care professionals, your pharmacists, your physicians."
Mike Adesso, a physical therapist with University Sports Medicine in Amherst and an athletic trainer, says his clients "sometimes tell me that they've got a little knee soreness or low back pain, and if they're taking an NSAID or some Tylenol and icing it and resting it for three or four days and doing some gentle stretching, that's all in the realm of trying to manage it by themselves.

"But if it's not getting better, it's time to go and see the doctor. You don't ever want to do it long-term on your own, it's never a good idea."
Alfonse Muto, a registered pharmacist and owner of Pine Pharmacy in Niagara Falls and Williamsville, cites long-term studies about stomach damage and inflammation. "Long-term, they're not curing anything," he says, "so it's just a Band-Aid approach to it. That's why I have people steer away from it."

Muto says he recommends that people coping with pain try natural remedies, which is the focus of his Williamsville pharmacy. "I try to get people to look at natural anti-inflammatories such as fish oil, boswella, bromelane from pineapple and spices such as tumeric," he says. "The first thing I recommend is fish oils, and then I try to talk to them about their diet, too, because most people's diets are very inflammatory. That's the approach we take here."

Muto is particularly concerned about gastrointestinal bleeding caused by aspirin, ibuprofin and other NSAIDs, an issue the FDA plans to address with its new labels. "The older you get, the more prone you are to gastrointestinal bleeding. But if they're taking 800 milligrams [of ibuprofin] three times a day, they should be concerned, no matter what their age."

Two people whose active lives might make them prime candidates for non-prescription pain relievers have developed ways to avoid relying on them.

Ellen Coleman, regional aerobic director for the Buffalo Athletic Club, maintains a grueling exercise schedule, working out about two hours daily. But she varies the types of workouts she teaches and so seldom resorts to a pain pill.

"I might use one once or twice a week," she says. "I might take two Advil on a Wednesday afternoon if my back or my knee is sore, but then that's it." The label on her ibuprofin bottle permits "one tablet every four to six hours when symptoms occur," she says.

Since her usage is well below the allowed dose, she says she's not worried by the new FDA warnings.

Roy Cunningham, a licensed massage therapist and avid pickup basketball player, says he relies on working out to maintain his muscles and joints before he hits the court. "Now that I'm over 40, I run at least twice a week, I do agility and speedwork, and I work on strength and flexibility," he says. "I do a lot of prep now. I've discovered that I can still perform really hard without training over age 40, but I'll really hurt. The only way to play without pain is to train. I do a lot of prophylaxis, a lot."

On the rare occasions when he does suffer an injury, Cunningham says, "I do the RICE thing -- rest, ice, compression and elevation -- pretty intensely, and then try not to lose range of motion and go right back into rehabbing things quickly, because atrophy accelerates as you get older."

When his massage work makes his wrists or knuckles sore, he says, "I'll take ibuprofin twice a week, but not every day," and uses the pain-relieving cream Tiger Balm, as well as gentle stretching.

But, says Cunningham, he finds pain relief in his favorite sport. "Honestly, basketball is the best analgesic I know. A lot of guys say this -- you get on a basketball court, you touch a basketball, and nothing hurts! You just feel better."


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