Editor’s note: The following is part of a class project originally started in Ball State University professor Adam Kuban’s class in the fall of 2021. Kuban continued the project this spring semester, challenging his students to find sustainability efforts in Muncie area and pitch their ideas to Ron Wilkins, interim editor of The Star Press, Journal & Courier and Palladium-Item. This spring will feature stories related to health care.
A bottle of over-the-counter pain relievers such as ibuprofen and Tylenol can easily be purchased at a local pharmacy for less than $10. No doctor’s appointments are required.
After taking a pill, the pain should disappear.
As the opioid epidemic in the United States continues, over-the-counter drugs, including nonsteroidal anti-inflammatory drugs and acetaminophen, have become a common alternative for pain treatment.
According to a Big Village survey published by the American Heart Association in 2023, about 3,000 US adults were surveyed and approximately 50% reported taking over-the-counter pain relievers once a week or more. Adults between the ages of 45-54 took them most often, and only about 30% of adults said they had talked to their doctors about the possible side effects of pain relievers.
Philip King and Lauren Czosnowski, pharmacists and internal medicine specialists at IU Health, said that every time a patient is admitted to the hospital, they document what medications they take.
“Almost every single patient will have frequent use of Tylenol or ibuprofen or other over-the-counter pain medication on their list, but they may not realize it’s an important topical medication,” King said.
Nonsteroidal anti-inflammatory drugs versus acetaminophen
The two main types of over-the-counter pain relievers are nonsteroidal anti-inflammatory drugs and acetaminophen — including ibuprofen, aspirin, and naproxen — and acetaminophen, also known as Tylenol. Both treat pain and fever, but work differently.
Nonsteroidal anti-inflammatory drugs and acetaminophen, according to University Hospitals, force your body to produce less prostaglandins. These play a role in controlling body temperature and irritate your nerve endings, which make you feel pain. Nonsteroidal anti-inflammatory drugs and acetaminophen are good at relieving pain from swelling and inflammation. However, acetaminophen, according to a 2023 study by Suneil Agrawal in “StatPearls: Treasure Island,” helps pain by inhibiting prostaglandins and acting on the hypothalamus region of the brain, which regulates body temperature. It is useful for arthritis and headaches.
Different medications have different dosages depending on age and weight, but King and Czosnowski said it’s not recommended to take more than 2,400 milligrams of ibuprofen, which is the equivalent of 12 pills, per day. For Tylenol, they said to never take more than 3,200 milligrams, or between six and nine pills depending on the amount in each pill.
“Especially with the recent concerns about overuse of opioids, we really want to try to use the safest and most effective pain medications,” Czosnowski said.
When people use ibuprofen consistently, according to the Cleveland Clinic, side effects can include diarrhea, gastrointestinal bleeding, kidney damage, high blood pressure, liver toxicity, heart attack, stroke and more. Ibuprofen can also interact negatively with other medications, such as other non-steroidal anti-inflammatory drugs or when taking blood thinners.
Acetaminophen overuse is the leading cause of acute liver failure in the US, according to University Hospitals.
Alcohol may not react well with pain relievers
King said mixing alcohol with pain relievers can also cause problems.
If someone takes Tylenol for a hangover, it can increase the production of toxic metabolites and cause further liver damage. Metabolites, according to the National Cancer Institute, are a substance that is produced when the body breaks down food, drugs or chemicals. It is part of the metabolism, which makes energy and materials necessary for growth, reproduction and maintaining health. It also helps to remove toxic substances. The side effects of this damage can take years to appear.
“Just because it’s over the counter doesn’t mean it’s not harmful,” King said.
Consider age when using pain relievers
According to a 2022 study by Victoria C. Ziesenitz published in “Pediatric Drugs,” nonsteroidal anti-inflammatory drugs are one of the most commonly used drugs in the pediatric population.
“I think it’s very important for patients or parents to be really careful in looking for the right formula for the child’s age,” Czosnowski said.
According to the American Heart Association, Generation Z, or people born between 1997 and 2012, were 30.5% less likely than other generations to ask health care professionals about alternative pain relief before taking over-the-counter drugs.
Even though Koran Jefferson is Gen Z, he made sure to talk to his doctor before taking ibuprofen first.
Jefferson is a sophomore criminal justice major at Ball State University and has been using ibuprofen since he was a junior in high school. After developing ankle and foot problems from playing football, he was put on Percocet. He took it for a short period before asking his doctor to give him ibuprofen and he has been taking it ever since.
Jefferson takes ibuprofen twice a day, three to four times a week. He plays basketball all week, so he takes 1,600 milligrams, or eight pills, 30 minutes before he plays. He said ibuprofen takes away most of the pain from his previous injuries, and other students who play basketball with him often take it, too.
“Our bodies are not the same as they used to be as children, so we need to [ibuprofen] to pass,” he said.
Whenever Jefferson starts playing basketball, he can immediately feel the pain in his leg. He said he participates in walking and everything hurts, especially when he runs. He always plays slow when he starts.
“That second and third game is when the ibuprofen really helped,” Jefferson said. “It gave me that energy instead of taking it away.”
Although ibuprofen has been helpful for him, he made his doctors aware of how much he was taking and they told him to slow down.
Jefferson didn’t hear it.
He knows there may be long-term side effects, but he has seen little impact.
The psychology of pain relievers
Psychologist and Ball State student Ari Gleckman said people often keep taking painkillers because they fear symptoms will return if they stop. While the risk of addiction to over-the-counter pain relievers is low, there can still be side effects after someone suddenly stops using.
“There’s something called medication overuse headache,” King said. “If someone is taking Tylenol every day and then they stop taking Tylenol, they may actually get a headache and feel like they need to take more Tylenol to get them off.”
Gleckman, who is the president of ASA (short for his children’s names) Concierge Psychological Services, a private mental health practice, helps patients with pain and addiction.
It primarily treats people who suffer from chronic pain that, according to the Cleveland Clinic, lasts longer than six months and may persist after the injury or illness has been treated.
Gleckman sees no reason to avoid over-the-counter pain relievers, as long as they are part of the protocol to reduce pain and not the entire protocol. He said people have become less tolerant of pain because they can go to a pharmacy and find a solution.
“Human beings don’t like pain,” he said. “Pain is something we will seek to contain and avoid.”
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