Special Report

April 30, 2017

Pain killers that kill

Pain killers that kill

By Chioma Obinna

Indiscriminate use and wrong prescriptions have remained a major global health challenge. Statistics from the World Health Organisation, WHO, show that more than half of all medicines are inappropriately prescribed, dispensed or sold.

On daily basis, Nigerians use drugs without knowing their side effects. Sadly, findings show increasing complications even deaths from indiscriminate use of these drugs.

Studies  also show that many medicines prescribed to patients expose them to undue risk while half of all patients fail to take them correctly.

In Nigeria, where there are weak health systems and underdeveloped mechanisms for routine monitoring of medicines, the problem is widespread.

Sunday Vanguard takes a look at indiscriminate use and prescription of painkillers and the consequences.

Undoubtedly, irrational use of drugs among Nigerians leaves much to be desired. Today, self-medication is the order of the day and abuse of prescription drugs is commonplace. Individuals have become self, doctors, nurses and pharmacists but experts say taking drugs without proper prescription could be harmful to health as all medicines are potential poisons.

No thanks to this singular act as every day people suffer from pain and take painkillers due to many conditions such as cancer, headaches, menstrual pain, arthritis, injuries, surgery and other chronic diseases for relief, without considering the other sides of painkillers.

According to medical experts, pain is characterised by physical uneasiness that ranges from mild discomfort or dull distress to acute often unbearable agony, such as pricking, throbbing or aching and typically leads to evasive action. It may be severe enough to require medication. In these situations, painkillers come handy, but these medications have their side effects. Recently, studies showed that more than 36 million people take over-the-counter and prescriptions for pain relief every day.

Hospital statistics show that poor prescription practices across Africa, and Nigeria in particular, has put many patients at risk. Sadly, unless an illness really gets out of hand, Nigerians with their carefree attitude would hardly think of seeing a medical doctor.  Today, self-medication has become the order of day despite medical experts’ position that every drug is a poison.

Many Nigerians may have died unknowingly due to indiscriminate use of painkillers.   Some notable Nigerians have also succumbed to this unfortunate development.  Only last week, Senator Isiaka Adeleke, who was said to have had heart attack, died of alleged overdose of painkiller drugs.   His death is just one out of many  deaths, mostly unreported, as a result of drug abuse.

Statistics available show that, each year, adverse drug events–injury resulting from the use of medication–result in over hundreds of thousands of visits to hospital emergency departments. But most adverse drug events are preventable. A former Chairman, Lagos State Association of Community Pharmacists of Nigeria, ACPN, Aminu Yinka Abdusalam, says painkillers were the most abused drugs worldwide and that many people die from painkiller overdose.

According to him, more people overdose from painkillers every year than from heroin and cocaine combined.

He said knowing the side effects of painkillers would reduce abuse of them. To  him, for mild to moderate pain associated problems, such as back pain or headaches, simple painkillers such as paracetamol and anti-inflammatory agents are the best way to relieve the symptoms.

Abdusalam warned that all painkillers have potential side effects. “So you need to weigh up the advantages of taking them against the disadvantages,” he said.

“When people have pain, they often take pain medicines called NSAIDs (Non-steroidal Anti-inflammatory Drugs). Ibuprofen is also in other over-the- counter drugs.

“NSAIDs help ease pain and inflammation. But if you have high blood pressure, heart failure or kidney disease, you should not take an NSAID. And you should not take any drugs that have Ibuprofen or NSAID in them.   This is because NSAIDs are bad for your blood pressure and can cause high blood pressure. And if you have high blood pressure, they can make it worse. This increases your chances of having heart attack or stroke.

“Also, it has been found that NSAIDs are bad for your heart and kidneys. Long-term use of NSAIDs can make the body hold onto fluid. This can make the symptoms of heart failure, such as shortness of breath, swollen ankles, and a rapid or irregular heartbeat, worse. They can also keep the kidneys from working well. This makes taking NSAIDs risky for people who already have kidney disease.”

Separately, Acting Head, Department of Biochemistry and Nutrition, Nigerian Institute of Medical Research, NIMR, Dr. Oluwagbemiga Aina, said people should not be taking painkillers like they are taking sweet. They shouldn’t be abused and should be normal dosage because abuse could lead to cardiac arrest.

“Therefore, painkillers should be taken two tablets 3 times daily for two days, that is, morning, afternoon and night and, if the symptoms persist, the person should consult a doctor.”

Which painkillers can you use if you have heart or kidney disease?

There is no simple answer. The best painkiller to use depends on your health problems. It also depends on any other drugs you take.  It is necessary to tell the doctor about any prescription drugs, over-the-counter drugs or herbal medicines you take.

However, over-the-counter Tylenol (generic acetaminophen) is often the best choice for people with high blood pressure, heart failure  or kidney problems.

Again, experts have pointed out that high doses of Tylenol can damage the liver, hence, the need to take the lowest dose to get enough pain relief.

Again, drugs like Tramadol are not used in people with epilepsy because taking it with some other drugs can increase the risk of seizures.

Studies have also found that taking prescription drugs that include traditional NSA-IDS as well as new generation anti-inflammatory drugs (COX-2 inhibitors) have been linked to cardiovascular risks.

The researchers in the study performed a comprehensive analysis of all randomized controlled trials that compared any NSAID with other NSAIDs or placebo. The analysis included more than 30 trials that examined in total more than 116,000 patients.   Drugs such as Rofecoxib (Vioxx) and Lumiracoxib were associated with twice the risk of heart attack, while Ibuprofen was associated with more than three times the risk of stroke. Etoricoxib (Arcoxia) and Diclofenac were associated with the highest risk of cardiovascular death.

Experts say these cardiovascular risks are worrying because many patients have both cardiovascular disease and musculoskeletal disease, and suggest that it is time for an evaluation of a broader range of alternatives.

Myths about painkillers

When it comes to prescription pain medications, there’s a lot of misinformation. However, Dr Richard Rosenquist, Chairman of Pain Management at Cleveland Clinic, debunked beliefs that the more you take painkillers, the better they work, explaining that more does not equal better. “It’s true that in the short term — after a severe injury, for example — two pills may be more effective than one at relieving pain. But, over time, taking too much backfires.”

He said that research suggests that chronic use of pain medications sensitizes a portion of the nervous system and modifies the way your brain and spinal cord interpret pain signals.

Rosenquist added: “You develop a tolerance to the medication over time.  Sometimes if you take chronic pain medications for a long time, your pain may actually get worse.”

He explained that if an individual starts taking a prescription pain medication for a legitimate reason, the individual runs the risk of addiction.  “It has nothing to do with moral character and everything to do with the highly addictive nature of these drugs,” he stated.

According to him, addiction was not the only risk that comes with prescription pain medications.

“When they are taken for extended periods of time, they also can harm the body endocrine system and throw the hormones out of whack, affecting everything from the libido to the risk of osteoporosis,” he emphasised.

“There are a lot of bad things that can happen, but people don’t always hear you when you describe them.”

On avoiding painkillers altogether, he stressed that there is scary information about painkillers. However, there are certainly legitimate uses. In addition to treating the pain from acute injuries, a very small fraction of chronic pain patients see improvements in both pain levels and function from taking pain medications — especially when other pain management techniques fail for them.

For the majority of people, though, prescription pain medications should be a short-term treatment at most.

Rose-n-quist added that pain medication can only mask the symptoms; but don’t treat the root cause of the pain.

How to manage your pain without taking drugs

There is no “quick fix” to treating pain, but rather it requires a lifestyle change that will be well worth the effort – and far safer than resorting to potentially deadly pain-relieving drugs.

Non-drug treatments, such as yoga or massage, can often reduce or even replace the need for drugs. Here are some things you can try, depending on your kind of pain:

Back pain: Stay physically active. Walking is a good choice. Acupuncture, massage, physical therapy, and yoga can help reduce pain, too. And care from a chiropractor may help.