Wednesday 22 November 2017

Overuse of strong painkillers can actually be a cause of headaches

Dr Nina Byrnes
Dr Nina Byrnes

Dr Nina Byrnes

QUESTION: I attended my GP recently for a check-up. While I was there, I asked her for a prescription for Solpadeine as I take it for headaches that I suffer from. I was surprised when she said that regular painkillers might not be the best thing for my headaches, and that they could even be making them worse. How is this possible?

ANSWER: Headaches or any recurring pain can be very debilitating and disturbing. When pain strikes, the first stop for many people is their local pharmacy. There are many over the counter pain remedies available and it can be hard to decide which one to use at any particular time.

Codeine-containing compounds, such as Solpadeine, are available over the counter in Irish pharmacies, although their use has been restricted in recent years. It is for this reason that many of those who were using such remedies regularly now have to attend their GP and request a prescription for these drugs.

As a GP, I feel the regulation of the sale of codeine-containing products has been a very positive thing, as it has encouraged people to think about the painkillers they are choosing and forced them to discuss it with their pharmacist or doctor.

When it comes to pain, a step wise approach to medicine should always be used. As doctors, we refer to the analgesia ladder. Paracetamol and ibuprofen are the first steps on this ladder. These are very effective for most day to day pain. They also act to help reduce fever and are, as such, particularly good drugs to take in the case of a cold or flu.

No medicine is safe in large doses and it is important not to take more than the recommended amount. Overdose of paracetamol can cause liver failure and death.

Ibuprofen belongs to a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDS). If these drugs are overused, there is an increased risk of stomach ulcers and bleeding, kidney damage or failure, increased blood pressure and cardiovascular damage.

If paracetamol and ibuprofen don't relieve pain, then moving up the ladder is appropriate. Codeine-containing products are the third step on the ladder. In many countries, codeine is only available on prescription and many feel the same should be the case here. Used correctly, codeine can be a very effective painkiller, however, abuse of codeine-containing products is increasing and most doctors I know have come across patients who are taking these products on a regular basis.

Codeine is an opiate painkiller which means it is derived from morphine. As with all opiates, addiction and tolerance can develop if these are used regularly. Higher doses are required to have the same benefit. The extra danger lies in the fact that most over the counter codeine preparations are combined with other drugs such as paracetamol and ibuprofen and so, increasing the amount of codeine you use also leads to increasing and potentially damaging or dangerous doses of these also.

Apart from its addictive properties, codeine is a sedating painkiller and so can be especially dangerous if mixed with alcohol. Other problems associated with codeine can include nausea or chronic and sometimes severe constipation.

Regular use of painkillers for headaches can also lead to what is referred to as an analgesia overuse headache. This is a headache that occurs when painkillers are reduced or stopped. The risk is highest in those taking painkillers more than twice a week for more than three months. It is estimated that 10% of those who suffer chronic headaches are getting them due to overuse of painkillers. Ultimately, the chronic headaches are actually due to a form of withdrawal from the painkillers being used.

If medication has been used for a long time, it may be necessary to reduce it slowly to help reduce the withdrawal effects. Headaches may initially get worse as painkiller use reduces but, ultimately 70% to 80% of people who suffer analgesia overuse headaches manage to quit medication and feel better. Studies have suggested that up to one in three people aged between 18 and 24 take over the counter painkillers on a daily basis.

Many times these are being taken as a way of preventing pain or headaches which can ultimately lead to overuse. So what do doctors recommend? If you have a simple pain, consider the cause. Headaches may be due to fatigue or dehydration – getting some rest and fluids may help. For sore joints, an anti-inflammatory rub, heat or ice may help. If you need painkillers, try taking paracetamol or ibuprofen alone first. For a severe pain, occasional use of an over the counter combination codeine preparation is ok, but if you regularly need painkillers for any reason, they should be taken under a doctor's supervision and advice. It sounds like your doctor is right and she is trying to make sure you are not at risk of analgesia overuse. Codeine may occasionally be the correct drug for you, but it's not the pill for every ill.

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