We tend to think of over-the-counter pain relievers as completely safe.
But even these medications have risks, so it’s important to follow instructions on how to take them. And if you have ulcers, you need to be very careful before taking over-the-counter (OTC) pain relievers. Several common illnesses can irritate the lining of the stomach, worsen ulcers, and possibly cause serious problems.
“People think if a drug is available over the counter, it has no risks,” says Byron Cryer, MD, a spokesperson for the American Gastroenterological Association. “But about a third of ulcers are caused by aspirin and other pain relievers. More than half of bleeding ulcers are caused by these medications.”
The problem isn’t just with over-the-counter painkillers. Many remedies for colds, sinus problems, and even heartburn contain the same ingredients.
If you have ulcers, you need to avoid any foods or medications that will make your condition worse. So, before you grab a bottle of pain reliever to soothe your aches and pains, learn some tips and dos and don’ts.
How do pain relievers work?
Somehow, all the pain is in your head. When we feel pain, it is the result of an electrical signal being sent from the nerves in a part of your body to your brain.
But the whole process is not electric. When tissues are injured (due to a sprained ankle, for example), cells release certain chemicals in response. These chemicals cause inflammation and amplify the electrical signal coming from the nerves. As a result, they increase the pain you feel.
Analgesics block the effects of these pain chemicals. The problem is that you can’t focus most pain relievers specifically on your headache or bad back. Instead, the drug travels through your entire body. This can cause some unexpected side effects.
What are the risks of developing an ulcer?
Why do painkillers increase the risk of digestive problems? The same chemicals that amplify pain — which some pain medications block — also help maintain the protective lining of the stomach and intestines. When a pain reliever stops these chemicals from working, the digestive system becomes more vulnerable to damage from stomach acids.
For people with ulcers, the most dangerous pain relievers are non-steroidal anti-inflammatory drugs, or NSAIDs Non-steroidal anti-inflammatory drugs. they include aspirinAnd the ibuprofenAnd the naproxen Sodium, and ketoprofen, the active ingredients in medications such as Advil, Aleve, and Baverine.
Other pain relievers may be less dangerous. acetaminophen It works differently and poses far fewer risks of digestive issues. But like any drug, it has its own side effects. You should not take any over-the-counter pain reliever for more than 10 days without your healthcare provider’s approval.
The risks of NSAIDs are very serious. Studies show that people who use NSAIDs are about three times more likely to experience gastrointestinal bleeding. Even in low doses, NSAIDs can make mild ulcers much worse.
Aspirin has additional risks. “Aspirin can help prevent blood clots, which is why it helps people who are at risk for heart attacks and strokes,” Cryer says. “But in people with ulcers, it can lead to more serious bleeding in the digestive tract.”
What if I have an ulcer and are at risk of a heart attack or stroke?
“People need to talk to their doctors to find out what’s best for their condition,” he says. But in people at high risk of heart attack or stroke, he says, aspirin’s cardiovascular benefits can outweigh its gastrointestinal risks.
If you have an ulcer, what should you do the next time you have a headache? In general, people with ulcers should use acetaminophen for over-the-counter pain relief. Unless your doctor says it’s okay, you should not use aspirin, ibuprofen, ketoprofen, or naproxen sodium. If acetaminophen does not help relieve your pain, see your doctor.
Other options for pain relief
Painkillers are not the only solution to many of life’s pains. Many effective and safe alternatives have no side effects at all.
- ice packsFor acute injuries such as an ankle sprain, it can keep swelling down and relieve pain.
- the heat Using a hot towel or heating pad can help treat chronic overuse injuries. (However, heat should not be used on recent injuries.)
- Physical activity It can help reduce some types of discomfort, such as arthritis pain.
- relaxation Using techniques such as yoga or meditation – may relieve pain. Biofeedback may also help. These methods are best for pain that is amplified by stress, such as tension headaches.
- unconventional techniques Low-risk treatments, such as acupuncture, benefit some people.
So remember: Pain relief doesn’t just come from the pill bottle.
The pros and cons of pain relievers
Below is a summary of the benefits and risks of some common pain relievers. This should help streamline your choices when you’re at the drugstore.
Keep in mind that no pain reliever should be used on a regular basis. If you are experiencing this severe pain, you need to speak with your doctor.
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- How it works. Acetaminophen is not an NSAID. Experts aren’t actually sure how it works, but it appears to affect chemicals that increase pain.
- Benefits. Acetaminophen reduces pain and reduces fever. Unlike aspirin and other NSAIDs, acetaminophen is thought to be safe for people with ulcers. It does not affect the natural lining of the stomach. Since it does not thin the blood, it does not increase the risk of bleeding either. Safe for pregnant and lactating women.
Side effects and risks. Experts say that acetaminophen is safe for people with ulcers. But like any other drug, it can cause other side effects. Very high doses of acetaminophen — well in excess of the recommended maximum of 4,000 mg/day — can cause serious liver damage. Long-term use of acetaminophen in high doses – especially when combined with caffeine (Excedrin) or codeine (Tylenol with Codeine) can lead to kidney disease.
Acetaminophen does not reduce swelling, as can aspirin and other NSAIDs. It may be less useful in treating pain caused by inflammation, such as some types of arthritis.
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- How it works. Aspirin is a non-steroidal anti-inflammatory drug that circulates in the bloodstream. It prevents the effects of chemicals that increase the feeling of pain.
Benefits. Aspirin has earned its reputation as a “super drug”. Relieves pain and relieves fever. It can also reduce inflammation, which means it can treat the symptoms (pain) and sometimes the cause (swelling).
Aspirin also reduces the risk of blood clots, heart attacks, and strokes, especially in people who are at risk of developing these problems. Usually, only very low daily doses — 81 milligrams, or one child’s worth of aspirin — are recommended for cardiovascular protection. Other NSAIDs (such as ibuprofen, ketoprofen, or naproxen sodium) and acetaminophen do not have this effect. However, you should never start taking a daily aspirin without first talking with your healthcare provider.
Side effects and risks. Aspirin can cause or worsen ulcers. If possible, people with ulcers should avoid it. Even in very low doses, aspirin can cause gastrointestinal symptoms, such as: heartburnor stomach upset or pain. Coated or “buffered” aspirin does not reduce these risks. Over time, ulcers can cause swelling and a buildup of scar tissue. This can become so severe that it can prevent food from leaving the stomach.
Aspirin can be dangerous for people with liver disease, gout, juvenile arthritis, or asthma. Rarely, aspirin may cause ringing in the ears or hearing loss.
Pregnant women should not use aspirin, as it can harm the mother and cause birth defects. Unless your healthcare provider says it’s okay, children and teens should not use aspirin because it puts them at risk of developing Reye’s syndrome.
While inflammation can cause pain, it is often an essential part of the body’s natural healing process. Because aspirin in high doses can prevent inflammation, it can also slow down recovery after certain injuries.
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- How it works. Like all NSAIDs, ibuprofen blocks the effects of chemicals that increase pain.
- Benefits. Ibuprofen can lower fever, relieve pain, and reduce inflammation.
Side effects and risks. People with ulcers should not use ibuprofen unless health care providers say it is safe. Ibuprofen can cause or worsen ulcers. It also causes other digestive symptoms, such as heartburn, upset stomach, or pain. Drinking alcohol while using ibuprofen increases your risk of developing gastrointestinal problems.
Ibuprofen may also increase your risk of heart attack and stroke. The US Food and Drug Administration (FDA) is now requiring drug companies to highlight ibuprofen’s potential risks. Use of this drug with other NSAIDs in pregnant women has been linked to birth defects.
Some people are allergic to ibuprofen and other NSAIDs. It can cause hives and facial swelling. It can be dangerous for some people with asthma. People with ulcers should avoid ibuprofen if possible. In some cases, ibuprofen can slow down the body’s natural healing process.
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- How it works. Ketoprofen blocks the effects of chemicals that increase pain.
- Benefits. Ketoprofen can lower fever, relieve pain, and reduce inflammation.
Side effects and risks. People with ulcers should not use ketoprofen unless healthcare providers say it is safe. Ketoprofen can cause or worsen ulcers. It also causes other digestive symptoms, such as heartburn, upset stomach, or pain.
Drinking alcohol while using ketoprofen increases your risk of developing gastrointestinal problems. Ketoprofen also increases the risk of heart attack and stroke. The FDA is now requiring drug companies to highlight these risks.
Use of this drug with other NSAIDs in pregnant women has been linked to birth defects. In some cases, ketoprofen can slow down the body’s natural healing process.
- How it works. Naproxen sodium blocks the effects of chemicals that make pain worse.
- Benefits. Naproxen sodium can lower fever, relieve pain, and reduce inflammation.
Side effects and risks. People with ulcers should not use naproxen sodium unless healthcare providers say it is safe. Naproxen sodium can cause or worsen ulcers. It also causes other digestive symptoms, such as heartburn, upset stomach, or pain.
Drinking alcohol while using naproxen sodium increases your risk of developing gastrointestinal problems. Naproxen sodium may also increase your risk of heart attack and stroke. The FDA is now requiring drug companies to highlight these risks.
Use of this drug with other NSAIDs in pregnant women has been linked to birth defects. In some cases, naproxen sodium can slow down the body’s natural healing process.
Many pain relievers, including high-dose NSAIDs, are available by prescription. Because they are stronger versions of over-the-counter NSAIDs, they often have the same or greater risks. Some examples are Daypro, Indocin, Lodine, Mobic, Naprosyn, Relafen, and Voltaren.
Cox-2 inhibitors are a relatively newer type of NSAID. Although these medications are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. It may also increase the risk of heart attack and stroke.
Two of these drugs, Vioxx and Bextra, have been withdrawn from the market due to various side effects. The Cox-2 inhibitors that are still available are Celebrex, Mobic, Relafen, and Voltaren.
Narcotics are another type of prescription pain reliever. Examples include OxyContin, Percocet, and Vicodin. These medicines are for people with severe pain. In general, they pose fewer risks to people with ulcers. It has other side effects, including constipation, fatigue, and risk of addiction.