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Pain medication overuse a real problem

September 17, 2008

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Suffer from frequent headaches? Talk to a doctor before reaching into the medicine cabinet again, advise the editors of Consumer Reports.

Overuse of prescription and over-the-counter pain medications can make headaches worse, according to CR's medical adviser Orly Avitzur, M.D., who reports on how some consumers inadvertently create their own headaches.

"People tend not to think of headache pills, especially those they can buy without a prescription, as 'serious' drugs," Avitzur says. "But, used improperly, even drugs like acetaminophen, ibuprofen and aspirin can increase headache pain. Instead of reaching for a pill when a headache comes on, people should consider alternatives. Relaxation techniques, exercise and acupuncture can all help ease headache pain. People who suffer from frequent or severe headaches should see their doctors."

CR notes that regular use of pain relievers can bring on a condition known as medication-overuse headache, which affects up to two-thirds of patients who seek help at headache treatment centers. The International Headache Society defines medication-overuse headaches as those that are present for at least 15 days a month or have developed or markedly worsened because the sufferer used too much medication.

The problem can be caused by prescription pain medicines, over-the-counter pain relievers or combinations of medications. Almost all such drugs have the potential to cause medication-overuse headaches. CR reports that some experts believe the main culprits are preparations containing barbiturates (such as Fioricet and Fiorinal); opioids; acetaminophen; nonsteroidal anti-inflammatory agents such as ibuprofen (Advil and generic) or naproxen (Aleve and generic); and migraine-specific drugs called triptans (such as Imitrex and Maxalt).

According to CR, the ready availability of nonprescription pain relievers on drugstore shelves and in many homes may be contributing to the problem. A recent CR survey of more than 6,000 subscribers confirmed that most of their medicine cabinets did contain over-the-counter pain-relief drugs, including acetaminophen (73 percent), ibuprofen (73 percent) and aspirin (69 percent).

In a separate survey of 47,283 CR subscribers conducted last year, 31 percent admitted that they did not always carefully follow directions on labels. Those who routinely overused drugs justified it because their pain was severe, they felt no side effects or they believed that their above-average weight or height warranted additional medication.

It has been estimated that about 25 percent of Americans exceed the recommended dosage when they take nonprescription pain drugs. And it's not just headaches that beget headaches when overtreated. In a March 2008 European Journal of Neurology study of patients at a rheumatology clinic who were taking pain relievers for joint pain and arthritis, researchers found that 70 percent were overmedicating and 8 percent exhibited symptoms of medication-overuse headaches.

Tips for treating pain

Consumer Reports offers the following four tips for treating headache pain:

¢ Use pain medications properly. Always follow label directions for how to take the medication, and don't take the medication more than twice a week. People whose headaches persist should see a doctor.

¢ Talk to a doctor. Chronic headache sufferers should inform their doctors of all prescription and nonprescription drugs they're taking, including any supplements.

¢ Explore alternatives. Pills aren't the only way to treat headache pain. Non-drug treatments such as acupuncture, biofeedback, physical therapy and relaxation techniques can also be effective.

¢ Cut down on pain drugs. People who have medication-overuse headaches should work with their doctors to taper off the drugs. They should also ask their doctors whether a drug designed to prevent headaches (a prophylactic agent) might help them.

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