Introduction: Know Your Painkillers, Part I
By Salvador Quiroz
It has sometimes been said that to heal pain is the work of gods. The healing of pain is certainly one of the main objectives of medicine. I will deal today and in my next column with physiological pain, beginning with a very concise and brief analysis of what some painkillers can do to you, mostly to grab your attention.
1. Salicylates and Acetyl Salicylic acid (aspirin):
The most common side effects include nausea, gastritis, bronchial spasms, constipation and allergic reactions. It is widely used as a preventive drug in clotting incidents such as heart attack, blood clots or embolism that forms in veins. Also, when taken long term for pain, as in chronic headaches or arthritis, you can experience severe withdrawal effects if you suddenly stop taking the medications. In other words, you take aspirin for headaches, but if you stop, one of the symptoms will be such a severe headache that you immediately go back to taking the drug. Also, when the amount of aspirin you take exceeds the ability of your body to metabolize and ultimately eliminate it (usually through the kidneys), the resulting toxicity may endanger your life.
The first warning signals of aspirin toxicity are usually a high-pitched ringing in your ears and inability to focus your eyes. If things progress, your blood turns acid, and you eventually fall into a coma. Treating acetyl salicylic acid coma is one of the greatest challenges in medicine. Mortality is high, and the decision to use emergency hemodialysis to purify the blood is often taken.
Be advised, I am talking about chronic, high-dose aspirin users and not the one-a-day low-dose baby aspirin users who take it as a blood thinner on the advice of their cardiologist, neurologist, or vascular surgeon. Nevertheless, I always advise chronic aspirin users, be they high- or low-dose, to wear an identification bracelet. In the event of an accident, this information can be essential to emergency room physicians.
2. Metamizole (Neomelubrina, Conmel, Prodolina)
The main danger of painkillers that have metamizole as their active ingredient is a depression or toxicity to the bone marrow, and, as a consequence, the inability of this organ to manufacture platelets, white blood cells, and red blood cells. If the bone marrow toxicity is irreversible, death may result from infection, hemorrhage, anemia, or a combination of all three.
Metamizole-containing drugs have been banned in the United States, but not in Mexico. However, my personal opinion, shared by most Mexican physicians, is that the danger of these drugs has been highly exaggerated and its effectiveness and price greatly exceeds its danger.
You may certainly ask your doctor not to prescribe a drug containing metamizole, but if you find out that you have inadvertently been taking one, please do not panic, because the chances of having a bad side effect are about as high as going into a coma through the use of aspirin.
Everyone should know that all medications have potential unwanted and even dangerous side effects. It is certainly the obligation of the pharmaceutical companies to make these known, but it is also the responsibility and ultimate decision of your physician to use them or not.
Dr Salvador Quiroz, Internal Medicine and Kidney Disease, Hospital H+, Graduated from the Mayo Clinic. Tel: 152 2329.