Jagged Little Pill. The Truth About Painkillers

Are you quick to pop a couple of tablets when a headache hits? Do you regularly include an over the counter painkiller in your shopping list? They may be the cause of your problem, or could even be seriously harming your health…


Twenty-five per cent of women regard painkillers as an essential handbag item on a par with their house keys, according to a recent survey I read. The average Briton consumes 375 over the counter painkillers a year, with women being twice as likely as men to buy them. However, as many as two thirds of us doesn’t know the difference between aspirin, paracetamol, ibuprofen and codeine, and many women have no idea about the serious side effects these tablets can cause if taken the wrong way. It didn’t take a huge survey for me to acknowledge that within my friendships there are many people who take painkillers daily or almost daily. I myself have been a regular consumer of them at times – in fact I was once extremely distressed when my “favourite” painkiller was taken off the market in Britain and I took to traveling around pharmacies near and far trying to snap up the remaining packets. I also ordered some on Amazon and celebrated its delivery in quite an over the top fashion. I remember saying to my mum, “there are so many people who have a packet of this in their medicine box and don’t realise how much other people like me need it!!!”.  So I’m not sitting in my magpie nest judging anyone. However, the next time you have a headache, here are five slightly alarming facts to think about before you reach for that pill packet

Some combination painkillers can be addictive

In some counties, such as the US, codeine products and their equivalent are only available by prescription, so there’s an added layer of safety but in Britain, Europe, Australia and New Zealand, you can buy them over the counter in any pharmacy as combination painkillers (for example, anything with Plus in its name). Codeine comes from the same family as heroin. It’s stronger than aspirin, ibuprofen and paracetamol and can be highly addictive. The 2007 National Drug Strategy Household Survey found more than 520,000 Australians had used painkillers for non medicinal use in the previous six months. A similar UK survey showed that half of all women used painkillers more than once a week. And young, professional woman are more at risk, because we are so strongly targeted by painkiller marketing and more likely to take them for tension headaches and period pain.

People start taking these drugs for genuine medical problem, but you can also gain a feel-good benefit from codeine, says neurologist Dr Michael Gross. Like heroin, you crave more. So, how do you know you’re addicted? One sign of addiction is needing to increase the dose to get the same pain-killing effect, similarly if you suddenly stop taking the tablets and have withdrawal symptoms such as sweating, tremors or diarrhoea, these are signs of addiction,

Taking eight or more paracetamol in 24 hours is an overdose

Paracetamol is the leading pharmaceutical agent responsible for calls received in poisons information centres in Australia and New Zealand and the U.K. The calls aren’t just from people who are deliberately overdosed – unfortunately it’s quite easy for people to do so accidentally. Every winter there’s a sharp increase in accidental overdose related deaths due to people combining different brands of cold and flu remedies for multiple days.

Anything above the recommended eight tablets in 24 hours is classed as an overdose. Following an acute overdose (24 tablets taken all in one go) liver failure is possible. But damage can occur even after a small overdose, particularly in patients with risk factors such as chronic alcohol use. People don’t realise that products including some cold and flu remedies, contain paracetamol, so it’s very easy to overdose.

Most pharmacy staff can advise you on the ingredients of products but always read the label.

Also, people tend not to eat when they’re feeling ill, the risk of paracetamol toxicity increases due to the lack of amino acid in the liver. Another lethal combination is mixing ibuprofen tablets and gels. Don’t use them together unless your doctor has instructed you to.

Another danger is that when people are in a lot of pain, they wake up more at night and take more tablets. It’s easy to make the mistake of thinking that it’s okay to take a couple more, since you’ve not had any for four hours, but you have to bear in mind the daily limit is based on a 24 hour period, so if you’ve already had your eight tablets during the day, you shouldn’t be having any more through the night.

They can cause the headaches you’re trying to cure

Painkillers are the first things the majority of us turn to if we have a headache or any aches and pains but did you know that as well as relieving headaches, they can cause them? They’re called analgesic dependent headaches and are the biggest issue dealt with in many headache clinics. A person will start taking a painkiller to cure a period of headaches, but end up with painkillers fuelling the headache because they’ve become reliant on them. The patient may then suffer withdrawal symptoms, including headaches, when they stop taking them. This type of rebound headache can often be worse at night without pain-killing drugs. Opiate drugs, such as codeine, are the painkillers most implicated in these analgesic dependent headaches, although doctors aren’t sure why this is. Aspirin and paracetamol is less likely to cause this problem, but do still carry a risk. If you’re regularly taking painkillers, speak to your doctor, as this kind of use can lead to analgesic dependent headaches.

They can reduce your fertility

A group of painkillers called non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can make it hard for women to conceive. These drugs work by inhibiting certain enzymes. This in turn can delay or prevent ovulation. In fact, sometimes high-dose NSAIDs are prescribed for this very reason. It’s fine to take them for the few days before and during your period (they have been shown to significantly reduce blood loss as well as easing pain in people with heavy periods) but they should be avoided the rest of the time if you’re trying to conceive. Also, NSAIDs are associated with a significantly increased risk of miscarriage, so it’s best not to take them if there’s a chance of you becoming pregnant.

They can interact with other drugs

Mixing different types of painkillers at the same time can be risky. Taking ibuprofen and high-dose aspirin in the same day can trigger a gastrointestinal bleed, so don’t mix unless your doctor tells you otherwise. However ibuprofen and paracetamol combine well, especially if you stagger them. Always take ibuprofen with food or you’ll risk getting stomach ulcers and gastric irritation. Ibuprofen  and paracetamol are safe to take after drinking, but not codeine, as it enhances the sedative effort of the drug.

As well as alcohol, there are other stimulants that may interfere when you take certain kinds of painkillers. Caffeine can interact badly with painkillers, some pills contain caffeine to speed up absorption but a US study on migraine patients showed that regular use can make chronic headaches four times more likely. Regular migraines should always be checked up by your doctor.

Some other things to remember….

Lastly, I just wanted to point out that if you do decide you need to pop some pills to relieve your symptoms, then remember different sorts of pains call for different medications. I know that sounds simple but I know so many people who don’t know which type of painkiller is best for their ailment. Non-steroidal anti-inflammatories like Ibuprofen or Nurofen (Nurofen is just a brand name of Ibuprofen) works best for things with an inflammatory cause, so joint pains, toothache or injury related ailments. Paracetamol is best for non nerve pains or combined with ibuprofen. Codeine is stronger so if you find that paracetamol or ibuprofen aren’t Woking,  try codeine. It’s sold in combination with paracetamol in pharmacies. You can still use ibuprofen if you move onto a codeine and paracetamol combo.

If you need pain relief fast, then soluble painkillers are a good option as they ‘kick in’ much quicker. These are also a good option if you want something gentle on the stomach, such as when you’re hungover! A word of warning, though; research carried out by University College London and The University of Dundee found that recommended doses of the most common versions of these soluble varieties contain 50 per cent more salt that the safe daily limit, putting you at risk of high blood pressure, heart attack and strokes if used long term

This NHS Drug Info Sheet is jam-packed with information on different painkillers and is a great resource when researching which painkiller is right for you, when you really require them, prior to heading out to the chemist!