Pain Medication: Risks and Alternatives

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Information Resources / Additional Information and Links to Scientific Studies

  1. A January 13, 2011 article in the New York Times reveals that the FDA is finally announcing a sharp restriction on the use of the most popular pain medications due to the enormous amount of death and liver damage resulting from acetaminophen overdosage from numerous sources, including most prescription pain medications, and most over-the-counter nonprescription pain medications since the dangers of NSAIDS have become more widely known. The FDA announcement: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm239894.htm
  2. A 2015 meta-review of randomized controlled studies of acetaminophen (Tylenol, or paracetamol), by experts at the University of Sydney, Sydney Medical School, the George Institute for Global Health, and the Institute of Bone and Joint Research, reviewed 13 randomized controlled human clinical trials and found that these clinical trials "showed no effect of paracetamol (acetaminophen) on pain intensity or quality of life measures measured by the 12-item short form health survey at short term follow-up" compared placebo for low back pain, and for osteoarthritis of the hip or knee "a small benefit when compared to placebo in reducing pain, while interventions such as targeted "exercise compared with no exercise control result in large treatment effects for pain reduction". "Moreover we found higher risk of abnormal results on liver function tests in patients taking paracetamol". Why such information was not published decades ago (this was published in the British Medical Journal, or BMJ, online) is the question the public should be asking, as acetaminophen is the main medication in almost all narcotic pain meds, usually at a high dosage: http://www.bmj.com/content/350/bmj.h1225
  3. A 1999 study from the Oxford University School of Medicine Pain Research Center and the University Hospital in Geneva, Switzerland, showed that large cohort studies with high-quality quantitative analysis confirms that 1 in 1200 patients taking NSAIDS for at least 2 months will die from gastrodoudenal complications that would not have taken the drug. Since the well known incidence of GI bleed and complications have been known for a century and downplayed to insure compliance with pain medication these statistics probably underestimated the risk of death, but do show an expanded look at the array of complications caused: https://www.researchgate.net/profile/Henry_Mcquay/publication/12622217chronic_NSAIDS000.pdf
  4. A 2016 meta-review of common pain medications that have been the backbone of standard treatment of osteoarthritis, NSAIDS and acetaminophen, by experts at the University of Bern, in Switzerland, found that acetaminophen (paracetamol) has not been supported by evidence and in general provides no proven pain relief greater than placebo, while various NSAIDS provide mild pain relief and some improved function. Diclofenac 150 mg (Voltaren) was found to work best of the NSAIDS. Such study shows that decades of standard care in osteoarthritis have been misleading and not evidence-based, and the experts reviewing against recommending acetaminophen, which is the main ingredient in most opioid pain medications as well, and cautioned that use of NSAIDS should be limited due to the evidence of adverse health effects with chronic constant use. The message is that we need to integrate conservative therapies in the care of osteoarthritis, such as physiotherapies, joint and soft tissue mobilization and acupuncture, as well as herbal and nutrient medicines to aid tissue repair: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2816%2930002-2/abstract
  5. A 2011 FDA press release outlines the problems seen with acetaminophen poisoning, and new requirements instituted to start decreasing the large problem of acetaminophen liver damage and death: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm239894.htm
  6. The array of signs and symptoms resulting from liver toxicity is explained succinctly on medical websites like this: http://www.wellness.com/reference/conditions/liver-toxicity/symptoms-and-causes
  7. A simple explanation of liver toxicity and the effect on the P450 catabolic pathway especially is explained on this website: http://www.articledashboard.com/Article/Liver-Toxicity-101---the-P450-Pathway/961346
  8. A list of medications that could cause liver damage is listed on this website: http://www.hepcnet.net/drugsandliverdamage.html
  9. A long-term study of 64,332 children and mothers in Denmark, and conducted in part at UCLA, and published in JAMA Pediatrics, found that acetaminophen use during pregnancy, especially during fetal brain development in the second and third trimesters, was associated with a 17-37 percent increase in risk for ADHD by age 7, with hormonal disruption, neurotoxicity, and increased oxidative stress cited as the causes: http://newsroom.ucla.edu/portal/ucla/use-of-acetaminophen-during-pregnancy-250121.aspx
  10. A 2013 large cohort study with over 3000 paired children followed by the University of Oslo, the Norwegian School of Public Health, and the Hospital for Sick Children in Toronto, Canada, showed that use of acetaminophen in pregnancy for at least 28 days of the term was highly associated with childhood behavioral problems, poor communication and gross motor skills: http://www.news-medical.net/news/20131030/Long-term-use-of-paracetamol-during-pregnancy-increases-risk-of-adverse-effects-on-child-development.aspx
  11. A 2015 report on the incidence and mortality of gastrointestinal bleeding, from the University of Texas Southwestern Medical School, in Dallas, Texas, U.S.A. found that nonvariceal bleeding of the upper GI tract continues to be significant health problem, even with much endoscopy procedure and gastric acid inhibiting therapy now performed, with considerable mortality (death resulting) and morbidity (incidence of serious disease in a population). The chief risk factors for the upper GI bleeding are NSAIDS, aspirin, SSRI anti-depressants, and overuse of blood thinners in cardiovascular disease, along with H. pylori overgrowth, which may be a result of poor stomach health, not a cause. These experts point out that many of the newer NDAIDs have been removed from the market due to severe warnings: http://www.ncbi.nlm.nih.gov/pubmed/26142028
  12. Long-term use of NSAIDS is known to increase GI bleeding and stomach ulcers, but this study shows that mucosal lesions in the colon, and ulcerative colitis may be caused by long-term use of these pain relievers: http://www.ncbi.nlm.nih.gov/pubmed/19817771
  13. Long-term use of NSAIDS is also shown to injure the small intestine, and COX-2 inhibitors, created to decrease such GI injury, is proven to be similar in damaging the small intestine, suggesting that the cyclooxygenase 2 (COX2) enzyme is important in maintaining small intestinal health: http:/www.ncbi.nlm.nih.gov/pubmed/17625980
  14. Long-term use of NSAIDS and other anti-inflammatory drugs is proven to result in many serious potential health problems. Here, the Institute of Cardiology in Chieti, Italy, studied the effects and reports that there is a high association with atrial fibrillation, a risk factor for heart attack, and NSAID use. We see from this study summary that standard medicine is loath to blame medication for any health problem, though, and speculates that this is due to inflammation causing atrial fibrillation, rather than inflammatory dysregulation from long-term NSAID use causing atrial fib: http://www.ncbi.nlm.nih.gov/pubmed/20837831
  15. A meta-review of all controlled randomized clinical trial of NSAIDS, published in the medical journal the Lancet, in 2013, shows that almost all NSAIDS, including ibuprofen, come with considerable cardiovascular risks that are similar in scope to the COX-2 inhibitors that were taken off the market in 2004 due to this liability. Higher dosage and chronic use of NSAIDS doubled coronary events, and increased fatal cardiovascular events by 3 per 1000 patients. Only Naprosen was shown in studies to have less cardiovascular risk: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2960900-9/abstract
  16. A meta-review of over 99,000 cases of adults after their first myocardial infarction, or heart attack, by Danish researchers, published in the online journal of the American Heart Association, shows clearly that chronic NSAID use after a first time MI significantly increases risk of cardiovascular events and fatal heart attacks: http://circ.ahajournals.org/content/early/2012/09/07/CIRCULATIONAHA.112.112607.full.pdf
  17. A 2015 report from the University of Zaragoza School of Medicine, and the Institute for Health Research, in Spain, showed that low-dose aspirin was 'unique' among NSAIDs with potential to decrease cancer risk, and since a low-dose aspirin has little or no cardiovascular risk and GI risk, and acts as a reliable blood thinner, this may be the only real pain medication protocol that is highly recommended in a risk versus benefit scenario. Obviously, use of a low-dose aspirin combined with actual physical care from the Licensed Acupuncturist with skills in myofascial release and soft tissue mobilization, and herbal nutrient medicine, would provide a reliable and healthy protocol to address chronic pain: http://www.ncbi.nlm.nih.gov/pubmed/26093284
  18. A 2005 report from the United States Centers for Disease Control and Prevention (CDC) states that deaths from "poisonings"s exceeded deaths from firearms for the first time in our history since such statistics were recorded. These so-called poisoning deaths were made up of 91 percent of unintentional overdose or accumulative toxicity from drugs, with the vast majority of these attributed to pharmaceutical drugs, either taken recreationally, or just prescribed and causing unintentional "poisoning" from accumulation in the liver or other organs, and combination with other pharmaceuticals: http://www.cdc.gov/nchs/data/hestat/injury99-05/injury99-05.htm
  19. A 2013 report from the United States Health and Human Services reported that even with inadequate reporting accuracy of the cause of death of drug overdose that estimates in 2010 were that at least 60 percent of these overdose deaths involved pharmaceutical opioid pain medications. Unfortunately, the guidelines to correct this epidemic address only increased vigilance and regulation of prescription drugs, not the need to provide a better treatment protocol to reduce the use of these pharmaceutical medicines: http://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf
  20. A 2016 report from the U.S. Centers for Disease Control and Prevention (CDC) presents a stronger and more readable set of warnings and statistics for yearly deaths from prescription drug overdose with the rising alarm of narcotic or opioid pain medication overdose now primarily affecting the white population in the United States. These 2013 statistics show that over 44 per people per day were dying of prescription opioid pain medication overdose in the United States, across all age groups. By 2016, although we did not yet have the CDC data, it was obvious that this number had grown alarmingly! Not only the easy access to prescription 'Oxy' and cavalier attitude towards these narcotics, but the practice of recreationally combining these prescription pain medications with an array of other drugs to design different types of 'high' presents alarming danger of sudden death, not just from opiate sedation, but from CNS dysfunction: http://www.cdc.gov/drugoverdose/data/overdose.html
  21. A 2013 report from Brandeis University and he Heller School of Medicine notes that estimates of the societal cost of prescription drug abuse have reached $72 billion per year, with another $70 billion per year in healthcare fraud, with $45 billion of this paid by taxpayers in the non-private insurer healthcare realm. The continued allowance of such an attitude toward prescription pain medication availability and unregulated distribution, the subject of addiction, and the use of pain medication as the only tool in treating chronic pain for most patients must end: http://www.pdmpexcellence.org/content/economic-costs-epidemic
  22. The easy access to psych drugs and ADHD drugs (amphetamines) is now connected to the alarming availability of opioid pain medications and subsequent harm, especially the alarming rates of overdose deaths recorded. Here, we see a 2016 report from a Medical Doctor at the Albert Einstein College of Medicine, in New York, which finally publishes the rising number of overdose deaths from benzodiazepines, or anxiety medicatons, whose easy prescription rose dramatically between 1996 and 2013 despite strong warnings of addiction, withdrawal and rebound syndromes in a significant percentage of users. The dramatic rise in overdose deaths, now recorded as about 20 per day in the United States, is connected to our attitude towards prescription drugs, and thus the ignoring of the risks and harm from combining a number of drugs recreationally, as long as they are all prescribed medications: http://www.einstein.yu.edu/news/releases/1155/overdose-deaths-from-common-sedatives-have-surged-new-study-finds/
  23. By 2015, the number of people addicted to pharmaceutical narcotic pain medications rose dramatically, and with the 2010 change in manufacturing of the most popular street drug, Oxycontin, to prevent easy powdering for injection or snorting, the rise of another prescription pain medication, Oxymorphone, or Opana, rose dramatically, resulting in another dramatic rise in yearly deaths attributed to overdose with prescription pain meds. This Reuters article outlines the problems, including the variety of ways this expensive drug is distributed, with doctor shopping, easy prescription, sales by patients, and street availability from pain clinics and marketers. At up to $90 a pill, the economic toll is also frightening: http://www.reuters.com/article/2012/03/27/us-drugs-abuse-opana-idUSBRE82Q04120120327
  24. Even deaths from recreational heroin use have spiked dramatically in 2013 because the heroin is being cut with the pharmaceutical narcotic fentanyl, according to public health experts and the attorney general in Maine. Fentanyl, the most recent synthetic narcotic marketed, is a poor pain reliever, but so dangerous for accidental death, that it was approved in forms other than pills, used as a topical patch, and (as crazy as it sounds) a lollipop! How this drug is then finding its way onto the street is not being questioned: http://www.fosters.com/apps/pbcs.dll/article?AID=/20140704/GJNEWS_01/140709606
  25. A 2014 article in the Journal of the American Association of Nurse Anesthetists reports on the negative interactions between the newer narcotic pain medication Fentanyl and SSRI antidepressants, resulting in Serotonin Syndrome, a potentially fatal condition of induced serotonin activity in the CNS: http://www.ncbi.nlm.nih.gov/pubmed/25842648
  26. A 2014 Bloomberg News report on lawsuits concerning the heavy false advertising to physicians prescribing OxyContin formulations that were supposed to prevent drug abuse revealed that $160 million has been paid out so far, and that over $1 billion may be awarded to the state of Kentucky, perhaps representing only the tip of the iceberg due to the level of harm these pharmaceutical narcotics have created: http://www.bloomberg.com/news/articles/2014-10-20/purdue-says-kentucky-suit-over-oxycontin-could-be-painful
  27. A research article in the September 2009 issue of the medical publication NeuroImage outlines the mechanisms by which simple acupuncture stimulation exerts an objective mind-body therapeutic response of significance in pain relief, affecting key areas of the brain responsible for pain modulation, and noted the dramatic difference between the measurable effects of so-called sham acupuncture stimulation (stimulation of the trigger points cutaneously) and real acupuncture stimulation with a deeper triggerpoint needling. This seminal fMRI and PET scan study of the brain effects of acupuncture stimulation was conducted by researchers at the Unversity of Michigan in coordination with Kyunghee University in Korea and the Massachusetts General Hospital Martinos Center for Biomedical Imaging, associated with Harvard. This is just one of the array of effects that simple acupuncture stimulation has in the body to promote healing and pain relief holistically. This study demonstrates how the mu-opioid pain receptors were also modulated to increase sensitivity, thereby theoretically enhancing the effects of standard narcotic pain medications and allowing the physician and patient to reduce dosage: http:/www.ncbi.nlm.nih.gov/pmc/articles/PMC2733781/
  28. A 1997 study of chronic pain patients by the Multidisciplinary Pain Center of the Danish National Hospital, in Copenhagen, Denmark, found that an array of health problems occur in a majority of patients with chronic pain, including sleep disorders, anxiety and depression, and that neurogenic pain, for which opioid pain medication has no effect, occurred in 65 percent of the study population. This type of study indicated the need for a multidisciplinary and holistic approach to treat comorbid conditions and improve quality of life, yet standard medicine in the United States rejected Integrative and Complementary Medicine and instead drastically increased prescription of opioid and other pain medications as the total package of care: http://www.sciencedirect.com/science/article/pii/S0304395997001267
  29. A 2010 study at the University of Southern Denmark found that the odds of recovery from a chronic pain condition were almost 4 times higher among individuals not using opioid pain medication, and that use of high-dosage opioids was associated with a poor health-related quality of life. Studies such as these indicate the benefits of a comprehensive package of care utilizing acupuncture, physiotherapy, herbal and nutrient medicine, and other health disciplines to treat the underlying problems with chronic pain: http://www.ncbi.nlm.nih.gov/pubmed/20842015
  30. The National Birth Defects Prevention Study, an ongoing population study sponsored by the Centers for Disease Control and Prevention (CDC) found in 2009 that use of opioid pain medication taken between 1 month before pregnancy and through the first trimester was associated with a higher incidence of birth defects (American Journal of Obstetrics and Gynecology: 2011;204:x.ex-x.ex.): http://www.ajog.org/article/S0002-9378(10)02524-X/abstract
  31. A 2002 study at the University of Wisconsin School of Medicine and Public Health found that chronic use of inhaled corticosteroid, such as asthma med inhalers, had a high association with risk of acquiring obstructive sleep apnea: http://chestjournal.chestpubs.org/content/135/5/1125.abstract
  32. A variety of studies have shown by 2012 that long-term use of opioid pain medication results in hormonal suppression, with both the hypothalamic-pituitary-adrenal axis and the gonadal production of hormones suppressed, including the important hormones that are responsible for tissue repair and maintenance, and regulation of inflammatory processes, such as cortisol, testosterone and estrogen. http://www.medscape.com/viewarticle/549294_5 These hormonal effects may result in male as well as female infertility, lowered libido, and increased aggression.
  33. A review of studies of hormonal, or endocrine, effects in humans resulting from chronic opioid medication use was presented in a February, 2010 article published in Endocrine Reviews. Here, researchers at Charles Drew University of Medicine and Science, the University of Western Ontario, the University of Texas at El Paso, and the Western University of Health Sciences in Pomona, California, showed that chronic use of opioid pain medication not only affects the standard sexual steroids, but increases thyroid stimulating hormone levels (TSH), producing a diagnosis of subclinical hypothyroidism: http://edrv.endojournals.org/content/31/1/98.full
  34. The most conservative listing of common side effects of the corticosteroid prednisone is listed here, on About.com, accredited by Health on the Net http://ibdcrohns.about.com/cs/prescriptiondrugs/p/medprednisone.htm
  35. The adverse psychological effects of corticosteroids in children and adolescents may be accessed at this website: British Medical Journal: http://adc.bmj.com/cgi/content/full/90/5/500
  36. Standard listing of common side effects of corticosteroids is listed at this website: Lymphomation.org: http://www.lymphomation.org/side-effect-prednisone.htm
  37. Respiratory Medicine vol.100, issue 8; 1307017 (Aug 06): http://www.resmedjournal.com/article/PIISO9546110500510X/abstract
  38. A meta-review of scientific study of pain treatment with acupuncture was conducted in 2012 by the esteemed Sloan-Kettering Cancer Center in New York, U.S.A. and published in the Archives of Internal Medicine, perhaps finally dispelling the notion that acupuncture only produces a placebo effect and is not proven over so-called placebo acupuncture. This article in the New York Daily News interviews some of the researchers that now suggest that acupuncture for chronic pain treatment can no longer be dismissed, and who found that professional needle manipulation is proven to exert more profound effects than simple needle insertion : http://www.nydailynews.com/life-style/health/sloan-kettering-study-acupuncture-works-chronic-pain-article-1.1156095
  39. A summary of the large meta-review of clinical studies of acupuncture for chronic pain conducted by Dr. Andrew Vickers et al at Sloan-Kettering Cancer Center in 2012 is presented here, in Archives of Internal Medicine, now called JAMA Internal Medicine: http://archinte.jamanetwork.com/article.aspx?articleid=1357513
  40. A study in 2014 at a Melbourne, Australia hospital showed that acupuncture was just as effective as pain medication for acute pain in an Emergency Room setting, which may lead to the introduction of acupuncture in hospital settings to decrease the risks and adverse effects even for acute traumatic pain: http://www.smh.com.au/national/health/acupuncture-as-effective-as-drugs-in-treating-pain-trial-shows-20140329-35qec.html#ixzz2zEP5buaT
  41. A 2014 randomized controlled study of electroacupuncture administered before and after surgery, integrated with Tramadol for control of pain, at the University Hospital of Thessaloniki "Ahepa", in Greece, showed that a simple 4 and 100 Hz stimulation at LI4 and ST36 significantly reduced pain and levels of the stress hormone cortisol, over the use of ketamine and Tramadol alone, improving outcomes in a number of ways: http://www.ncbi.nlm.nih.gov/pubmed/24480836
  42. A 2014 randomized controlled study of the use of electroacupuncture stimulation during surgery, at the Tianjin Medical University, in Tianjin, China, found that electroacupuncture at the points ST36 and SP6, combined with standard anesthesia, mitigated the adrenal cortical inhibition induced by anesthesia and improved levels of cortisol and ACTH during the surgery: http://www.ncbi.nlm.nih.gov/pubmed/24621826
  43. An example of proof of pain relief from acupuncture and electroacupuncture is presented here, published in 2006 in the Oxford Journal, Rheumatology. The researchers at Peninsula Medical School and the Universities of Exeter and Plymouth in England found that a review of all published studies showed that pain control with acupuncture and electroacupuncture was proven in randomized sham-controlled human trials for treatment of peripheral joint osteoarthritic pain: http://www.ncbi.nlm.nih.gov/pubmed/16936326
  44. A 2013 large randomized controlled human clinical trial for acupuncture stimulation of the periosteum of the knee in patients with painful chronic knee arthritis, at the University of Pittsburgh School of Medicine, and the Veterans Administration Pittsburgh Healthcare System, in Pittsburgh, Pennsylvania, U.S.A. showed that this acupuncture stimulation of the periosteum with brief electrical boosters modestly reduced pain over controls: http://www.ncbi.nlm.nih.gov/pubmed/24184053
  45. The neural physiological mechanisms of pain relief, or analgesia, from acupuncture and electroacupuncture are well studied, and reviewed in this article in Progressive Neurobiology: http://www.ncbi.nlm.nih.gov/pubmed/18582529
  46. A 2012 study at the Max-Planck Institute for Biophysics, Frankfurt, Germany, along with the University of California at Irvine, and the Shanghai Institutes for Biological Sciences, showed that acupuncture stimulation, which is documented to affect delta opioid receptors, exerts pain relief by strengthening the GABAergic system in the brain, through the effects of delta opioid receptors on the GABA transporter GAT1: http://www.ncbi.nlm.nih.gov/pubmed/23365600
  47. Scientific study in 2013 at the University of Manitoba, Canada, found in a controlled randomized human clinical trial, that acupuncture exerted local, as well as systemic, effects on the sympathetic nervous system, showing localized increase from baseline in healthy patients that were physically stressed of blood circulation and tissue perfusion, as well as skin conductance, and decrease in skin temperature. The modulatory changes ranged from 98 to 146 percent, proving the local circulatory effects of acupuncture stimulation: http://www.ncbi.nlm.nih.gov/pubmed/23376998http://www.ncbi.nlm.nih.gov/pubmed/18582529
  48. A randomized controlled human clinical trial comparing acupuncture, spinal manipulation, and medication for the relief of chronic spinal pain was conducted in 2003, and published in the medical journal Spine, a peer-reviewed journal published by Lippincott Williams and Wilkins, affiliated with many orthopaedic organizations around the world. This study showed that for chronic spinal pain, joint manipulation, or mobilization, produced the best short-term outcomes, followed by acupuncture stimulation, and lastly pharmaceutical medication. Combining joint mobilization and manipulation with acupuncture to relieve chronic spine pain is common in Traditional Chinese Medicine, with physicians skilled in both acupuncture and Tui na physiotherapy: http://journals.lww.com/spinejournal/Abstract/2003/07150/Chronic_Spinal_Pain__A_Randomized_Clinical_Trial.3.aspx
  49. While modern research into the efficacy of cannabinoids in marijuana, or Cannabis, for pain relief have been restricted for decades, Cannabis was a potent and much utilized pain medication throughout history, with numerous extracts in the late 1800s and early 1900s prescribed. Here, a 2013 case study at the University Hospital of Wales, United Kingdom, demonstrates that severe chronic pain that was poorly controlled with all other medication, was effectively relieved with a synthetic cannabinoid, greatly improving quality of life and reducing the needed doses of opioids and ketamine: http://www.ncbi.nlm.nih.gov/pubmed/23893276
  50. A 2006 meta-review of current scientific study of cannabinoids to treat pain, by Creighton University Medical Center, in Omaha, Nebraska, U.S.A. found that cannabinoids from marijuana, or synthesized, were very effective: http://www.ncbi.nlm.nih.gov/pubmed/16449552
  51. A 2009 study of cannabinoids in pain relief, at Hanover Medical School, in Germany, found that THC in combination with standard opioid pain relievers produced a synergistic effect and allowed for a much lower effective dosage of opioids, improving opioid tolerance: http://www.ncbi.nlm.nih.gov/pubmed/19236260

"long-term use of high-dose inhaled corticosteroid therapy has potential to cause systemic side effects – impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitiary-adrenal-axis suppression, measured by serum or urine cortisol decrease correlates with the occurrence of systemic side effects of high-dose inhaled corticosteroids."