My private practice in Beverly Hills focuses on delivering a holistic, multi-disciplinary approach to providing medical care to patients in pain. Unfortunately, many people don’t realize that pills, even over-the counter (OTC), provide a lot of medication to the body – often more than the amount needed to simply dull the pain. This excess medicine must be included because the liver acts as the filter for the body and knocks out about one-third of the medicine you take orally. The remaining medicine must then be spread throughout the entire body because your body doesn’t know that you are only trying to treat your sore knee or strained shoulder.
Every day across the country, millions of people relieve pain with the assistance of OTC pills without giving this a second thought. For the vast majority, when used as directed, they achieve relief for their pain safely. But pain medication can be tricky to manage due to the range of options and varying doses which is why the FDA is revamping the approval path for OTC drugs. As reported by The Wall Street Journal, “this move will change how tens of thousands of medicines and personal care items reach U.S. store shelves.”
Despite liver toxicity issues concerning doses over 325 mg, the FDA still allows a 500-milligram over-the-counter acetaminophen to be sold. “It is inexcusably poor judgment on the part of the FDA to have failed to take action concerning this major source of acetaminophen consumption, and, consequently, acetaminophen toxicity,” Dr. Sidney M. Wolfe, founder and senior adviser of Public Citizen Health Research Group in Washington D.C., told the Wall Street Journal.
Acetaminophen has a narrow therapeutic window. The difference between a safe, effective dose and an overdose — which, in serious cases, can lead to liver toxicity — is a relatively small increment in milligram consumption.
Ibuprofen, naproxen and even aspirin can cause stomach upset, and even ulcers, when not administered at the right dosages. Outside the United States, more people use a balance of topical and external medicines. Topical pain relievers such as creams, gels, patches and sprays work locally and largely reduce, although they do not entirely eliminate, the systemic risk – accidental or otherwise – that OTC pain pills can present.
Many people enjoy a few glasses of wine with dinner, or going out for beers after work. However, combining alcohol consumption with virtually all OTC pain relievers delivered in a pill label is against labeled use. According to the National Institutes of Health publication on alcohol and metabolism, liver damage can occur with as few as four to five extra strength acetaminophen pills consumed with varying amounts of alcohol. For a list of commonly used medicines that can interact adversely with alcohol, visit this National Institutes of Health page.
There are a variety of non-invasive techniques, procedures, specific acu-points and philosophies surrounding pain relief worldwide. With a topical, you can deliver much less medicine to the body because you’re applying it directly at the site of pain.
I encourage all my patients to use medicine as directed. It is important for pain sufferers to know their options and consider treating mild to moderate pain locally to improve their pain relief outcomes.
Dr. Aristotle Economou is a member of The Institute for Functional Medicine and Diplomate and Faculty Member of The International Academy of Medical Acupuncture, Doctor of Chiropractic and author of the book, Change the Way You Heal: 7 Steps to Highly Effective Healing.