Jenny L. F. Andrus, MD
As an Interventional Pain Management Specialist, I have a license to prescribe and an electronic prescription pad giving me access to pharmacies full of the most potent and chemically complex drugs that exist for the treatment of pain. However, in this series of articles, I’d like to focus on non-prescription pain relievers, which should be discussed for their role in the management of chronic pain. For some individuals, acetaminophen can be just as effective as the prescription “big guns” when used appropriately. For others, it can help work in combination to achieve better pain management.
The precursor to acetaminophen was discovered in the late 1800s and European and American researchers and physicians tinkered with it until the 1900s, trying to limit side-effects and maximize the analgesic qualities. By the 1950s, safety standards had been satisfied, so the pain-reliever that we know today began to be mass produced for human consumption by prescription only. By 1960, acetaminophen became available over the counter and today, is one of the most widely consumed drugs in the world.
Acetaminophen is marketed as a pain reliever and as a fever reducer: a treatment for headaches, dental pain, musculoskeletal pain, and menstrual cramps are noted uses. It is also recommended for those who cannot take aspirin or NSAIDs, due to stomach upset, bleeding issues, asthma, kidney, heart, or liver disease. It is also considered safe in low dosages for children as well as adults.
I would like to address the bad rap acetaminophen has for causing liver toxicity. Because it is metabolized through the liver, long-term, high dosages of acetaminophen do have the potential of causing liver damage and fatal liver failure. However, most physicians (myself included) who prescribe acetaminophen do not prescribe anywhere near the amount of this drug to cause this kind of liver toxicity. We also carefully monitor the liver function of our patients to ensure we aren’t causing damage through our treatment.
A concern may arise when patients start to supplement their prescribed amount of acetaminophen with more for breakthrough pain and not informing me about it immediately. That’s why it is so important for my patients to communicate with me about the efficacy of the treatments we are using, so that we can tweak them as needed without causing harm.
Acetaminophen isn’t considered a superior drug to NSAIDs for pain relief and research supports using ibuprofen or naproxen sodium for musculoskeletal pain and relief of inflammation. However, we are finding that using acetaminophen in conjunction with NSAIDS or even lower dose opioids can help these drugs work more effectively and deliver better pain relief for post-surgical or chronic pain patients. This is due to the cumulative effect of taking drug(s) over time in which repeated administration of a drug may produce effects that are more pronounced.
You might be surprised to know that acetaminophen is also added to many OTC and prescription drugs to make them more effective for pain relief and fever reduction. These are just a few:
Alka-Seltzer® Plus Liqui-Gels Lortab®
Dristan® Tylenol® with Codeine
Vicks® Hydrocodone Bitartrate
The next time you are prescribed a drug that contains acetaminophen or your physician recommends that you take one for your everyday ache or pain, you may better understand why and how it will work to make you feel better.