pain – watercress words by Dr Aletha

This week I discuss 7 groups of medications that are overused. This, and the next post about drugs which are underused, has many links; you may want to bookmark for future review.

medication capsules — Sometimes we need medication, but sometimes we don’t.

I call these drugs overused. However, I do not mean

That you should never take them
That you should quit using them
That your doctor should not prescribe them
That you should quit taking them if your doctor prescribed them
That they are bad or dangerous drugs

We should think more about when, why and how to use these drugs.

By drugs and medications, I consider any substance we put into our bodies to treat or prevent a disease or symptom, whether prescribed or over-the-counter (OTC), synthetic or “natural”. I’m not considering foods,nor any substance that is illegal or mostly recreational in this discussion.

I picked classes of drugs that I am most familiar with as a family physician so excluded highly specialized medications like cancer chemotherapy, cardiovascular drugs, anti-rheumatics and neurological drugs.

I based my assessment on my professional experience as well as medical literature and the opinions of other physicians. As always, your best source of information about the right drugs for your conditions is your personal physician.

Antibiotics

Every infectious disease expert says we use too many antibiotics unnecessarily-but we keep doing it. Doctors and patients share the responsibility of using antibiotics appropriately.

Reasons to avoid antibiotics

They don’t help most of the things we use them for, namely respiratory infections which are usually caused by viruses.

They add to the cost of medical care.

They frequently cause side effects; they are one of the top four causes of adverse drug reactions that lead to ER visits and hospital admission.

They can change the balance of the good bacteria that live in our bodies, the microbiome.

Here is a previous post about the use and misuse of antibiotics for respiratory infections, the most common culprit in the inappropriate antibiotic battle.

How to navigate the antibiotic highway

Opioid pain medication

These are the drugs that comprise the current opiate epidemic. Like antibiotics, they are a frequent cause for ER visits and admissions for adverse reactions. Unlike antibiotics, they can create physical and mental dependency and addiction, and can be fatal in overdose which is happening more often. The New York Times reports

Opioid poisonings increase in toddlers and teenagers

Some of the overdose deaths are accidental, especially in children, but in adolescents and adults are too often intentional.

Used properly, opiates relieve severe pain due to cancer, trauma,and surgery, but doctors and patients should consider other alternatives for less severe pain first, especially if it is a long term condition.

Dr. Sanjay Gupta, CNN medical correspondent, suggests doctors and patients work together to achieve pain relief without the risk of addiction.

“But most simply, we as doctors need to engage our patients and discuss treatment with them, whether its short term opioids or alternatives like physical and occupational therapy. We need to help set realistic expectations for our patients: Living entirely pain free is not always possible. As doctors, we need to have follow-up conversations with our patients to see how treatment is going. If we better understand our patients, we can provide better treatment and help develop pain strategies that are effective and safe.”

Talk to your doctor if you believe your use of opiate pain medication has become a problem.

Doctors must lead us out of our opioid abuse epidemic

lying woman with palm full of pills — Deaths from accidental and intentional opioid overdoses are skyrocketing.

Anti-inflammatory drugs

These are the non-steroid anti-inflammatory drugs, referred to as NSAIDs. This includes generic ibuprofen and naproxen, available in both otc and prescription strengths. ( Brand names include Motrin, Advil and Aleve.) There are other NSAIDs but these are most frequently used.

When these drugs first hit the market, we were excited to have effective drugs for people with joint pain from arthritis. Then we recognized they also worked well for headaches, menstrual pain, and other forms of muscle and joint pain.

Now they seem to have become the go-to drugs for almost any discomfort or symptom, with people taking multiple doses daily (often exceeding the recommended dose) without medical supervision.

Although usually well tolerated, they do pose risk to the kidney, heart and liver, especially in people who already have disorders of those organs. And they can cause stomach ulcers with bleeding in anyone.

Acetaminophen

The name Tylenol has become synonymous with the drug acetaminophen, although there are other brands and generic versions. Sometimes abbreviated APAP, this drug relieves pain and reduces fever, and is used frequently by adults who also give it to their children. It does not carry the risk of stomach ulcers as do the NSAIDs. However, it also can cause harm to the liver and kidney.

At this link you can

understand your OTC pain reliever options better

Sleeping medications

Many people have trouble falling asleep, staying asleep, or getting a restful sleep and turn to medications, both prescription and non-prescription for help.

Sleep specialists avoid the routine use of sleeping medications, due to lack of effectiveness long term and potential side effects and risks. They recommend altering conditions related to sleep such as bedtime, sleeping arrangements, temperature and activities, often called sleep hygiene, or mind-body interventions like meditation, hypnosis, yoga, tai chi and music.

Here is a Consumer Reports review of

Sleeping pills for insomnia

person sleeping on a couch — Sometimes getting a good night’s sleep can be a challenge.

Rescue inhalers for asthma

People use quick acting or rescue inhalers for asthma or COPD symptoms. The inhalers usually relieve symptoms promptly and if they aren’t, people may believe the inhaler “isn’t working”.

Instead, it may mean that the lungs aren’t “working” to full capacity and need more aggressive treatment. Continuing to use the inhaler repeatedly with little or no relief can be dangerous and lead to respiratory failure. Instead, you need to seek medical attention at a clinic or hospital emergency room.

This article explains

Inhaled asthma medications

Vitamins, minerals and other supplements

People spend $37 billion annually on vitamins, minerals and other supplements with little to no proof that they prevent or treat anything. Most nutrition scientists teach that appropriate eating will supply our requirements for vitamins and minerals.

Vitamins and/or minerals are recommended in some medical situations, including-

Pregnancy and nursing
People with intestinal disorders who absorb nutrients poorly
People with restricted diets for any reason
People with or at high risk of macular degeneration, a cause of blindness

Find out why

most adults don’t need dietary supplements

In a future post I will discuss non-drug alternatives to these drugs and others.

Listen to a podcast by two physicians at 2 Docs Talk

Are supplements good medicine?

Come back in 2 weeks to find out what 7 medications I call underused.

Whether it’s extra weight gained from holiday eating or excess weight you’ve carried for years, the new year is the perfect time to lose it.

I’ve written before about reasons to maintain a healthy weight at Why Obesity matters. Multiple health conditions including diabetes, heart disease, even cancer can stem from excess weight.

But here’s another reason to shed those excess pounds or kilos- pain.

Obesity increases the risk of chronic pain especially back pain , and weight loss leads to significant decrease in pain, sometimes more effectively than medications and surgery.

Pain in the spine , hips and knees may worsen with excess weight. (skeleton display at the Museum of Natural Science in New York City)

Pain management specialists discussed the relationship of obesity and back pain at the American Academy of Pain medicine annual meeting. Medical research studies conducted at the Mayo Clinic linked obesity to back pain. Other studies implicated obesity in cases of arm, knee, hip and back pain in adolescents as well as elderly people.