Tuesday, July 21, 2009

The FDA warns about the dangers of pain medications

Reading the newspaper and online articles lately has been startling. Recently, the FDA has sent out warnings against the use of Acetaminophen (Tylenol, Excedrin) and other pain medications like Vicodin and Percocet. The cover of Newsday a couple of weeks ago said that the FDA was considering banning Vicodin and other prescription pain relievers. Acetaminophen is one of the most commonly prescribed over the counter medications for pain and fever and the hydrocodone-acetaminophen combination drugs (Vicodin, Percocet) has been the most frequently prescribed drug since 1997. (JAMA 2002, Jan 16; 287 (3) 337-44.) So what's the danger? Well, from 1998 to 2003 acetaminophen was the leading cause of acute liver failure in the United States. There were an estimated 56,000 emergency room visits, 26,000 hospitalizations, and 458 deaths related to acetaminophen-associated overdoses per year during the 1990-1998 period. What about all the perhaps thousands of deaths each year from liver disease, kidney failure that might not immediately be linked to these medications? In April 2009, the FDA issued a final regulation that strengthens labeling for over the counter (OTC) products containing acetaminophen, which helps. I understand that a person has to be responsible and use the recommended dosage so as not to risk liver injury or death. I've worked with people with severe chronic pain for years and the danger is that when a person is suffering with chronic pain in the beginning they may think about the recommended dosage, but many times after severe, often debilitating pain, they may ignore these warnings and take an exceeded amount out of desperation. It's easy to take A pill for A headache, but it's much more difficult to "not exceed 4 grams per day" when you're willing to do just about anything not to suffer with severe, chronic pain. My experience with treating patients over the years is that many people are far exceeding the recommended dose and it seems like everyone has been prescribed Vicodin for something. I find it repugnant that often times, people go to the doctor in an effort to reduce their pain and the ONLY solution they are given are these potentially harmful medications. I understand that a doctor wants to help, but the patient should be given options. First, why is there pain? What's causing it? Second, what therapies are available that would help to correct the cause of the pain? Therapies like chiropractic, massage, acupuncture, physical therapy, yoga, and nutrition are excellent choices that are geared towards getting to the cause and thereby eliminating pain symptoms. Pain is a warning signal that something is out of balance. Most medical doctors nowadays recommend these therapies to their patients once a disease process like a tumor, fracture, etc. has been ruled out. Of course sometimes these therapies don't work for every single person and surgery is sometimes needed, but people should at least be given a CHOICE in their pain relief. If you or a family member go to a doctor for pain, ask what alternatives or complementary therapies he/she would recommend instead of potentially harmful medications. If that doctor has negative things to say about alternative therapies, get a second opinion. Please don't settle for a minimal physical examination or no examination followed by a prescription for pain meds. Advocate for yourself, insist on finding out why you have the symptoms you have. Don't settle on JUST symptom relief, find the CAUSE. If you went to an auto mechanic and he covered up your check engine light and said "the light should go off eventually" and did nothing to find out why the light was on in the first place, it would be disconcerting to say the least. Your body is your most precious asset.

~ Dr. Reynolds


  1. Thank you for this blogpost. It is encouraging and empowering because many doctors are VERY pushy about solving pain with medications and shots right away, before considering other options. Since they are more of an authority than I am in what is troubling me, it's hard to know which way to go sometimes. It helps me to be more confident about speaking up.

  2. Some traditional doctors are open to "alternative methods", but usually you have to be the one to come up with the suggestions first. Once they know that you prefer alternative methods, they may not be so quick to prescribe pain meds. I think they are used to people coming to them looking for prescriptions, for the most part. There are some really good M.D.s and D.O.s out there; you just have to ask around until you find someone you are happy with.


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