That painkiller could cause you more pain

What do you do about that nagging headache after a hard day at work? Pop a painkiller, right?

Well, that’s what most people do.

However, doctors are warning about the abuse of pain killers.

A Harvard University study published in the American Journal of Epidemiology shows that drugs used to treat mild to moderate pain associated with headaches, muscle aches, toothaches, colds, flu and menstrual cramps, or to reduce fever, could have adverse effects on your hearing and kidneys.

The study highlighted the adverse effects of uncontrolled and frequent use of analgesics on the body, noting that the pain relievers may be damaging the cochlea, the snail-shaped hearing mechanism in the inner ear.

Analgesic drugs are used to manage pain and work by blocking the production of chemicals which signal pain to the central nervous system, or by blocking the action of the chemicals at the “receptor” sites within the brain.

“Ibuprofen can reduce blood flow to the cochlea, which could result in cellular damage and cell death.

Acetaminophen may deplete the antioxidant glutathione, which protects the cochlea from damage,” says study author Dr Sharon Curhan, instructor in medicine at Harvard Medical School.

Acetaminophen, so known in the United States, Canada, Japan, South Korea, Hong Kong and Iran, is known as paracetamol in Kenya.

Dr Curhan warned that, although these painkillers are household names, they are potentially harmful.

In the study, women who took pain relievers at least twice a week were more likely to experience hearing loss, and more frequent usage increased the risk by up to 24 per cent.

“Frequent use of these medications and use over long periods of time may increase the risk of hearing loss and may cause other adverse health effects.

Therefore, it is important to take these medications mindfully and to limit their use as much as possible,” said Dr Curhan.

Our findings suggest that frequent analgesic use may also be an important but preventable contributor to hearing loss, she added.

“Because OTC analgesics are widely available without a prescription and perceived to be safe, frequent use of these medications has become very common.

However, most people are not aware of the potential harm these medications may cause and the possibility of adverse interactions with other medications, particularly when used frequently,” Dr Curhan noted.

The 14-year study, which began in 1995 and ended in 2009, examined 62,261 women between the ages of 31 and 48.

By the end of the study, 10,012 women had reported hearing loss.

Dr Curhan and her team corroborate previous research showing that men reported hearing loss after frequent and non-prescribed uptake of pain relievers.

Researchers now refer to the abuse of painkillers as a virtual epidemic since they are also destroying kidneys.

Closer home, ear nose and throat and kidney specialists note that people are increasingly taking painkillers to get rid of body pains which they attribute to long working hours and lack of rest.

Ms Lilian Kirwaki, who abused painkillers, told DN2 how this unregulated use led to kidney failure, which saw her put on a twice-a-week dialysis at a private hospital in Nairobi.

Because of her busy schedule and demanding city life, Kirwaki thought having a pack of pain relievers at strategic places — in her handbag, her office-desk, in her car and even by her bedside table — was a smart solution.

She is still shocked that these drugs changed her life so radically.

“I have been spending Sh18,000 weekly on dialysis at the cost of Sh 9,000 per session for the last one and a half years and I can no longer sustain it,” Kirwaki said, adding that she might have to undergo a kidney transplant, which will cost her at least Sh2 million.

“Painkillers have destroyed my life.

I wish I had taken it seriously then because I have always known that taking over-the-counter drugs is not good,” she says.

As she considered a transplant, she managed to get two potential donors after a series of medical tests last August, but one pulled out at the last minute.

A normal transplant costs Sh2.5 million in South Africa, and up to Sh1.8 million in India. Private hospitals in Kenya charge an average of Sh1.2 million.

Meanwhile, Prof Seth Mc’Ligeyo, a kidney specialist at the Kenyatta National Hospital, told DN2 that the number of people in Kenya who have developed kidney failure as a result of casually taking pain relievers is at an all-time high.

“While these pills provide quick relief, they are addictive and their prolonged and unmindful usage can cause massive damage to kidneys,” he warned.

“What surprises me is the impulsive intake of painkillers,” Prof Mc’Ligeyo told DN2 at his office at the renal unit at the Kenyatta National Hospital.

“Pain killers are not sweets, they are drugs and have side-effects if misused.”

Prof Mc’Ligeyo said it is normal to walk into a shop and ask for paracetamol for a headache or backache, with little regard for the rule that all drugs should be taken under prescription.

This ignorance has led to a high numbers of people dying of kidney failure in the country, he noted.

Occasional use not harmful

But Prof Mc’Ligeyo is quick to point out that taking painkillers occasionally is not harmful, adding that frequent usage can lead to serious health problems.

“These painkillers are not broken by the liver or the digestive system. These are excreted through the kidneys and thus damage them,” he explained.

He noted that judicious prescription of painkillers by doctors is also lacking, citing attitude as another challenge to the mindful use of pain killers.

Kidney damage that results from frequent use of painkillers is known as analgesic nephropathy.

Researchers estimate that it occurs mostly in women above 30.

According to Prof Mc’Ligeyo, people who have abused painkillers and suffered kidney failure include middle-aged women, people with depression and the elderly.

“Women take pain killers for all sorts of reasons, from back pain to menstrual cramps while those with depression have illnesses for which they always grab a pain killer, with little regard to the damage they are inflicting on their kidneys,” said the doctor.

He said the elderly are also notorious for self-medicating with painkillers, while those around them condone this hazardous habit.

“The abuse of pain killers causes renal papillary necrosis, a disorder of the kidneys in which all or part of the renal papillae die, leading to kidney failure,” Prof Mc’Ligeyo noted.

The renal papillae are the areas where the openings of the collecting ducts enter the kidney and where the urine flows into the ureters.

On matters hearing, ear, nose and throat (ENT) specialist Dr Mbira Gikonyo echoes Prof Mc’Ligeyo’s view that, while occasional use of OTC painkillers is not harmful, their use over long periods can cause hearing loss.

The exact manner in which these analgesic drugs lead to hearing loss is not known, but it is believed that they reduce blood supply to the cochlea and reduce the natural resistance of the inner ear to damage.

Research is ongoing.

The hearing loss seen in people who abuse analgesics varies from mild to moderate, with a few cases of severe to profound hearing loss as damage is also dependent on natural resistance to damage, which varies from one person to another. 

Dr Mbira pointed out that prolonged and uncontrolled use of pain relievers can also lead to tinnitus (ringing in the ears).

Dr Mbira noted that, although the increased risk of hearing loss from analgesic abuse is clear, the incidence is believed to be low.

However, the ENT specialist urged both policy-makers and pharmacists to discourage abuse of analgesics, which have can also cause liver damage as well as high blood pressure.

“Hearing is very important for both social and professional reasons.

If you cannot hear, you end up with both family- and work-related problems because the spoken word remains the key method of human communication in all fields of human endeavour.

It is, therefore, important to safeguard one’s sense of hearing against all causes of hearing loss,” Dr Mbira concluded.

Any medication whether prescription or non-prescription, should be discussed with your health-care provider, the doctors advised.

“No one likes pain, so pain relievers are popular and remain the best selling drugs worldwide.

Numerous common physical conditions such as back pain and headaches affect many, thus their common use,” said Dr Mbira, who is also a head and neck surgeon.

Some people find they cannot go through the day without relieving pain, leading to abuse of pain relieving medication, Dr Mbira added.