Editor's Note: The following is part of a class project originally initiated in the classroom of Ball State University professor Adam Kuban in fall 2021. Kuban continued the project this spring semester, challenging his students to find sustainability efforts in the Muncie area and pitch their ideas to Ron Wilkins, interim editor of The Star Press, Journal & Courier and Palladium-Item. This spring, stories related to health care will be featured.
A bottle of over-the-counter pain relievers such as ibuprofen and Tylenol can easily be bought from a local drug store for under $10. No doctor appointments are required.
After taking a pill, one’s pain should dissipate.
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 to treat pain.
According to a survey by Big Village published by the American Heart Association in 2023, roughly 3,000 adults in the U.S. were surveyed, and approximately 50% reported they took over-the-counter pain relievers once a week or more. Adults between ages 45-54 took them most frequently, and only about 30% of adults said they’d spoken to their doctors about the potential side effects the pain relievers can have.
Philip King and Lauren Czosnowski, pharmacists and internal medicine specialists at IU Health, said every time a patient is admitted to the hospital, they document what medications they take.
“Almost every single patient is going to have frequent use of Tylenol or ibuprofen or other over-the-counter pain medications on their list, but they may not realize that it’s an actual relevant medication,” King said.
Nonsteroidal anti-inflammatory drugs vs. 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 fevers but function differently.
Nonsteroidal anti-inflammatory drugs and acetaminophen, according to University Hospitals, force your body to make fewer prostaglandins. These play a role in body-temperature control and irritate your nerve endings, which cause you to feel pain. Nonsteroidal anti-inflammatory drugs and acetaminophens are good at easing pain from swelling and inflammation. However, acetaminophen, according to a study from 2023 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’s helpful for arthritis and headaches.
Different medications have varying doses depending on age and weight, but King and Czosnowski said it’s not recommended to ever take more than 2,400 milligrams of ibuprofen, which is equal to 12 pills, a day. For Tylenol, they said to never take more than 3,200 milligrams, or between six to nine pills depending on the amount in each pill.
“Especially with the more recent concerns on using opioids too much, we really want to try to use the safest, most effective pain meds,” Czosnowski said.
When people consistently use ibuprofen, 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 with other medications negatively such as other nonsteroidal anti-inflammatory drugs or when on blood thinners.
Acetaminophen overuse, according to University Hospitals, is the leading cause of acute liver failure in the U.S.
Alcohol may not react well with pain relievers
King said mixing alcohol with pain relievers can also cause issues.
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 made when the body breaks down food, drugs or chemicals. It is a part of metabolism, which makes energy and materials needed for growth, reproduction and to maintain health. It also helps get rid of toxic substances. The side effects of this damage can take years to show.
“Just because it’s over the counter doesn’t mean it’s not harmful,” King said.
Take age into account when using pain relievers
According to a study in 2022 by Victoria C. Ziesenitz published in “Pediatric Drugs,” nonsteroidal anti-inflammatory drugs are one of the most frequently used drugs in the pediatric population.
“I think it's really important that patients or parents are really careful about looking for the right formula for the age of the child,” 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.
Although Koran Jefferson is Gen Z, he was sure to speak with his doctor before initially going on ibuprofen.
Jefferson is a sophom*ore criminal justice major at Ball State University and has been using ibuprofen since he was a junior in high school. After he sustained ankle and shin problems from playing football, he was put on Percocet. He was on it for a short period before he asked his doctor to be prescribed ibuprofen, and he has been taking it ever since.
Jefferson takes ibuprofen twice a day, three to four times a week. He plays basketball throughout the week, so he takes 1600 milligrams, or eight pills, 30 minutes before he plays. He said the ibuprofen takes away most of the pain from his prior injuries, and other students who play basketball with him often take it, too.
“Our bodies aren’t the same as they used to be as children, so we need [ibuprofen] to get through,” he said.
Whenever Jefferson starts to play basketball, he can immediately feel the pain in his shin. He said he gets shin splints and everything hurts, especially when he runs. He always plays slowly when he starts.
“That second and third game is when the ibuprofen really helped me,” 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 takes, and they told him to slow down his usage.
Jefferson hasn’t listened.
He knows there can be long-term side effects, but he has seen little impact.
The psychology of pain relievers
Psychologist and Ball State alumnus Ari Gleckman said people often continue taking pain relievers because they’re afraid of symptoms returning if they stop. While over-the-counter pain relief addiction risk is low, there can still be side effects after someone abruptly stops use.
“There is something called medication-overuse headaches,” King said. “If someone is taking Tylenol every day and then stops taking the Tylenol, they may actually develop headaches and feel that they have to take more Tylenol for those to go away.”
Gleckman, who is the president of ASA (an abbreviation for his children’s names) Concierge Psychological Services, a private mental health practice, helps patients with pain and addiction.
He primarily treats people suffering from chronic pain that, according to the Cleveland Clinic, lasts beyond six months and can continue after the injury or illness has been treated.
Gleckman sees no reason to avoid over-the-counter pain relievers as long as they’re a part of the protocol to reduce pain and not the whole protocol. He said people haven’t become as 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 engage and avoid.”
This article originally appeared on Lafayette Journal & Courier: Can over-the-counter pain relievers cause health problems?
