Popping Painkillers. Is it safe?

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Painkillers are the most commonly used OTC drugs. Though they are considered safe enough to be dispensed OTC (Over-the-counter) without needing a prescription, they certainly have side effects and long-term toxicity.
Painkillers belong to the class of drugs known as NSAIDs (Non- steroidal anti-inflammatory drugs). These drugs treat fever, and pain and reduce inflammation in the body. NSAIDs/ Painkillers work by preventing the body from producing Prostaglandins. Prostaglandins cause inflammation and pain by dilating blood vessels and raising temperature.  Many people doubt how painkillers know where the pain is, painkillers like NSAIDs block the Cox enzyme thereby blocking the prostaglandins, and prostaglandins send signals of pain to the brain. Thus by blocking prostaglandins, pain signals to the brain are blocked, and all kinds of pain are reduced. Other types of drugs used for pain include narcotics and anesthesia. These drugs change the brain’s perception of pain, but today we are discussing only NSAIDs.
The most commonly used painkillers are Paracetamol / Acetaminophen (Tylenol), Ibuprofen (Motrin, Advil), and Naproxen (Aleve).  For adults the maximum per-day dose of Acetaminophen is 4000mg, Naproxen is 750mg, and Ibuprofen is 1200 mg.

The adverse effects of NSAIDs include NSAID-induced stomach ulcers, diarrhea, nausea, indigestion, headache, dizziness, fluid retention, and allergic reactions. Long-term use of NSAIDs can cause liver and kidney damage. NSAIDs like Diclofenac increase the risk of Angina, and patients with conditions such as Unstable Angina are at greater risk for Myocardial Infarction (MI) while taking NSAIDs. Aspirin is used as a blood thinner at lower doses (75mg) when used daily and as a painkiller at higher doses (325mg, 350mg, 500mg). Use of aspirin is not recommended in children below 18 years of age as there is a risk of Reye syndrome. Reye syndrome is a rapidly worsening condition of the brain. It causes swelling in the brain and liver. Symptoms include vomiting, personality changes, seizures, confusion, and loss of consciousness. It may lead to permanent brain injury or death. 


Use of NSAIDs should be avoided in pregnancy unless it is essential, even then the lowest possible dose should be used for the shortest duration. Acetaminophen is safe for use in pregnancy and lactation. NSAIDs should be particularly avoided in early pregnancy and the third trimester. NSAIDs can increase the risk of early pregnancy loss, fetal renal dysfunction, and other fetal risks.

Most NSAIDs pass in the breast milk, thus the lowest possible dose of NSAIDs should be used while lactating. Ibuprofen is considered safe to use while lactating.


Many people have a habit of popping in painkillers for every pain. It is important to remember the adverse effects of NSAIDs and their effects on the liver and kidneys. NSAIDs should be used only when necessary. Other forms of pain relievers like pain balms, topical pain patches, sprays, ointments, hot water, and ice bags should be used to manage pain. Even though these drugs are OTC, safe and conscious use of NSAIDs is necessary to avoid adverse effects and ensure healthy living.

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