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Blog Thread 4; Live Free or Blog Hard - 'cos we all like blogging
Carl-E:
Guys, guys - Tylenol / Acetaminophen / paracetamol is ridiculously dangerous. The maximum recommended dosage, if surpassed even for a brief amount of time, can devastate your liver. We're talking failure in a relatively short period of time (a couple of months).
And what's that maximum dosage?
1 gram, 4 times a day. Two of those extra strength tabs pictured above. Take a third at serious risk to your health. The regular strength is 325 mg, so three of them is still a safe dose.
Ibuprofin (Advil) will cause stomach upset, yes, but it takes massive amounts to do serious damage. Same with Naproxen Sodium (Aleve). All three (along with plain aspirin) are anti-inflammatories, which is how they reduce pain, and why they're mixed with codeine (you can get codeine mixed with any of the three, but Tylenol is most common) because codeine isn't an anti-inflammatory, it just kills pain by deadening nerves temporarily.
I learned some of this through my wife, a PA student, and the rest from an extensive report on the radio - here's the report, and a transcript. Warning: it's an hour-long program, but the bsics are laid out early.
No matter what you call it, be careful. "Some is good" rarely means "more is better".
GarandMarine:
I switched to naproxen sodium for my daily pain relief.
Carl-E:
I use it for the collapsing discs in my back - one in the morning, an occasional one in the evening. Ibuprofin works well for me for muscular aches and pains, and I only use Tylenol for my very rare headaches. It seems to do best on those for me, better than aspirin. None of them bother my stomach.
Aimless:
Saying that paracetamol is ridiculously dangerous because it will fuck you up if you take more than the maximum recommended dose every day for two months is like saying alcohol is ridiculously dangerous because it will fuck you up if you drink a bottle of wine every day for a couple of months. It's true, but, if you're overconsuming a substance for a long period of time, maybe the danger shouldn't be attributed entirely to the substance.
There are a few rare individuals that metabolize drugs differently from most other people to the point where they may be at significant risk of harm when using even normal or low doses of various drugs. Apart from these people, paracetamol is very safe for most people if you don't exceed the maximum recommended dosage of 1g x3-4/d. There is little to be gained from taking higher doses. If it works for you, but doesn't cover the whole day, you may consider slow-release formulations. If it doesn't work for you, maybe some other intervention is in order.
Every single class of painkillers is associated with a more-or-less significant risk of adverse effects. Ibuprofen, naproxen and other similar antiinflammatory drugs are generally well-tolerated by healthy youngish individuals, but we regularly get people in the ER with gastrointestinal bleeds most likely caused by these kinds of drugs. We also see the occasional hospitalisation due to interactions between these drugs and other more dangerous drugs. Tramadol is relatively safe for short periods when used appropriately (right regimen and for the right kind of pain), but we regularly get people in the ER who've had seizures from moderate-to-high doses of tramadol, and never mind the growing number of people who've become literally addicted to tramadol and can't kick it even after its efficacy has been drastically reduced. Codeine and similar drugs are extremely effective for many kinds of pain, esp. in combination with paracetamol, but lose their efficacy over time while the side-effects become increasingly prominent.
Every drug has its risks, but paracetamol is the only in the list above that is reasonably safe for almost everyone to use every single day as long as you stick to a reasonable dose, and reasonably effective for most kinds of mild-to-moderate pain, in combination with another class of drugs if necessary.
That being said, pain-treatment should be guided not only by concerns about safety but also--and primarily--by the type of pain. In many cases of acute and clearly inflammatory musculoskeletal pain, a short course of antiinflammatory drugs, ranging from ibuprofen to high-dose naproxen or the like, is the way to go. In many cases of chronic back-/neck-pain, I've had much greater success from referring patients to multimodal pain-rehabilitation, an experienced physiotherapist, a warm swimming pool or sauna, steroid-injections or nerve blocks, etc. In many of those cases, a drug directed towards a neuropathic component of the pain, can be a far more valuable supplement than any antiinflammatory or opioid drug. However, there's also a need for rescue-meds. For some people, nothing but opioid drugs seem to help, and those people end up at least having to switch drugs from time to time. And, with chronic headaches of various kinds, there's a large arsenal of more-or-less effective pharmacological and non-pharmacological treatments.
I realise I work in a country where people have greater and more affordable access to these measures, so all this is very easy for me to say. I also don't mean to offend anyone--you know your body and your pain better than I do, and you know what works for you and what doesn't. I speak only from my own experiences with patients who have been done a great disservice by the healthcare-system's sometimes irrational or uninformed approach to treating pain, and from my experience of what can be gained from taking a different approach. peace
Akima:
Interesting. Doctors here frequently recommend 2x665mg three times a day for chronic pain associated with osteoarthritis, in a specific formulation available as Panadol Osteo. It is supposed to be a layered "slow release" medication to provide eight hours of pain relief, but I don't know anything about the pharmokinetics beyond that. It is on the Pharmaceutical Benefits Scheme, but you can buy it without a prescription as a "behind the counter" medication, which is to say that you have to buy it through a pharmacist and they will warn you that you should take no additional paracetamol-based medicines at all. An alternative is 2x500mg four times a day. Doctors seem to be much more comfortable with this regime than, for example, meloxicam (Mobic), where they fret constantly about ulcers and intestinal bleeding, sometimes prescribing pantoprazole (Somac) as a sort of prophylactic.
I don't think paracetamol/acetaminophen is ridiculously dangerous. Exceeding the recommended dose of any medication is a bad idea, and I don't think that overdosing continuously for two months really counts as a "brief amount of time". It is probably a bad idea to self-medicate continuously with any pain-killer for two months without consulting your doctor, even if you don't exceed the recommended dose on the packet. There is a reason there is usually a warning to "See your doctor if pain persists" in the small print.
Disclaimer: I work at a hospital, but in IT. I have no medical training, I just have a grandmother who suffers from fairly serious arthritis.
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