Long-Term Effects of Pain Medication

Q:  My doctor has recommended daily Tylenol (acetaminophen) for the pain of arthritis in my shoulder. Although it seems to work, I'm concerned about taking an over-the-counter medicine daily.

Will it cause any problems with my vital organs? Will it lose effectiveness after long-term use? Must I take it daily or could I use it just when the pain gets bad?

A:  Of course, there is a possibility of adverse effects with any medication, be it over-the-counter or prescription. Although pharmaceutical companies test products before they are approved and the FDA monitors products for safety, sometimes a medication is approved and prescribed, and then, after further study, found to be a significant enough health hazard that it is pulled from the market. Such is the story of Vioxx (rofecoxib), another pain reliever found to cause heart problems in some people.

Acetaminophen, on the other hand, has the advantage of being available since 1955 and a nationwide best-seller for many years. (Notably, Vioxx was only on the market from 1999-2004.) The large, collective experience with acetaminophen suggests that any health risks are small, although, granted, this reasoning is not free of flaws. The FDA is reviewing the safety of acetaminophen as it reviews the safety of all the over-the-counter pain-relievers such as Advil (ibuprofen) and Aleve (naproxen).

We do know that acetaminophen is risky in two ways: first, in overdose, it is fatal. Do not use more than the recommended dosage (and even lower dosages if you have liver problems). Second, long-term high-dose probably increases the risk of kidney problems.

Still, acetaminophen is an effective, non-addictive pain reliever and a very good option for the daily bothersome pain of arthritis, because the alternatives all carry their own risks. If you like, you could use acetaminophen as you need it; acetaminophen does not offer any pain-relieving advantage if taken every day instead of taken "once in a while." (Except, if you take it regularly, you could prevent yourself from ever feeling the arthritis pain.)

For people with more severe pain, doctors sometimes prescribe stronger medications or send their patients for specialized care. There are many "pain clinics" that regularly work with people who have uncontrolled pain and the clinics can also help manage the side effects of any narcotic-type medications. They can also explain the risks of addiction and the role of narcotics in controlling chronic pain.

Dr. Stephen Abram is a Professor of Anesthesiology (Pain Management) at the Medical College of Wisconsin. He says that most pain management clinics work almost exclusively on a referral basis, so patients would need a recommendation from their primary doctor. Alternately, there are other ways to manage pain outside a doctor's office, such as physical therapy, acupuncture, and behavioral or relaxation therapy with stress management.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices internal medicine at the Froedtert & Medical College General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.