A COMPEDIUM OF DRUGS: ANALGETICS
Analgesic medications are used to dispel pain, but some have other effects as well. For example, aspirin (salicylate), a good pain reliever, lowers an elevated temperature and has an antiinflammatory effect. Some of its success in relieving the pain of arthritic conditions is because of its antiinflammatory effect, in addition to its analgesic action. Aspirin is sold in many forms, by prescription and over the counter. It is useful for many forms of pain affecting the muscles and bones. The most common side effect is an upset of the intestinal tract, and it may cause irritation and bleeding in the stomach. Some people experience a ringing in their ears when they take excess amounts. Aspirin has many other uses in addition to analgesia: it decreases the stickiness of the blood (tendency for blood to clot) and is used in the treatment and prevention of strokes and in some heart conditions.
There has been renewed interest in the use of aspirin as an effective agent in reducing the risk of heart attack. A number of recently published medical articles suggest that small doses of aspirin (325 milligrams every other day) may decrease the risk of a future myocardial infarction (heart attack). Some physicians are concerned that many older indi viduals may take aspirin without seeking their doctors’ advice and without knowing the potential risks of taking even a small dose of aspirin.
Even modest aspirin doses may cause bleeding of the stomach lining. The 85-year-old father of one of my associates began taking one aspirin every other day without consulting his physician, who might have warned him against this practice because of the man’s previously diagnosed stomach ulcer. My colleague’s father was later admitted to the hospital in a state of shock because of a bleeding ulcer, probably precipitated by the aspirin therapy. Ask your doctor before treating yourself and be aware of the signs that something might be wrong if you are taking small doses of aspirin.
Other analgesics are often prescribed for those who cannot tolerate aspirin but require treatment for pain. The milder medications that can be bought over the counter include acetaminophen, which may also help lower fever, as does aspirin. Although it was once thought to be relatively harmless, when taken in excess, it can have deleterious effects on the liver. It does not decrease the risk of heart attack. Propoxyphene, widely sold as a mild analgesic, can cause dizziness or fainting and should not be taken with alcohol. It probably should not be used at all in older individuals. Codeine usually must be obtained through a doctor’s prescription, although in some countries small doses can be bought over the counter. Codeine can cause a number of problems in the elderly, including constipation and mental confusion.
The more potent analgesics, called opiates, include morphine and meperidine. These substances are used only for short periods, such as for an injury or after surgery. They also play an important role in the treatment of malignant disease. In many instances these drugs are addicting and will cause a clouding of consciousness and lead to drowsiness or mental confusion. They must always be used under medical supervision.
The pain of arthritis and rheumatism, although sometimes relieved by analgesics, is usually more effectively treated with antiinflammatory drugs. The most important and best known, of course, is aspirin. For inflammatory disorders, however, aspirin may be needed in much larger quantities
than when used to treat other types of pain. A number of new medications, called nonsteroidal antiinflammatory drugs, are used for the treatment of arthritis. Some of the older drugs in this group, such as phenylbutazone and indomethacin, are very effective, but they may cause a severe gastrointestinal upset similar to aspirin. The exact place of the newer antiinflammatory drugs is now being established. Today, it is common for patients to be prescribed one of the newer forms of these medications, such as ibuprofen, naproxen, piroxicam, sulindac, diclofenac and tiaprofenic acid. For this reason it is especially important for you to check with your physician to see whether a similar drug is being used simultaneously for the same purpose.
*44\166\2*
