Overuse of pain meds can be life-threatening
Overuse of pain meds can be life-threatening
(Editor's note: This is the second of a two-part series on caring for ED patients who are abusing prescription or over-the-counter drugs. Last month, we gave strategies for screening and assessing these patients. This month, we cover medical problems that result from overuse of pain medications.)
A 35-year-old man told ED nurses at University of Colorado Health Sciences Center in Denver that he had severe back pain and reported taking three or four 500 mg acetaminophen tablets every two hours for the previous week.
"When we saw him, he was jaundiced, had acute liver failure with an ALT of 12500, and renal insufficiency," recallsKennon Heard, MD, assistant professor of emergency medicine at University of Colorado School of Medicine in Denver. "He was evaluated for transplant and not felt to be a good candidate, but fortunately he recovered after a week in the ICU."
ED patients who overuse over-the-counter (OTC) pain medications such as acetaminophen, ibuprofen, or naproxen are coming to EDs with serious medical problems such as peptic ulcer, gastritis, and liver injury, says a new study.1 Because many ED patients have limited access to health care, they often overuse OTC medications for treatment of pain because they have no alternative, says Heard, the study's lead author.
Researchers surveyed 546 patients, and 307 reported using a pain or cold medication containing ibuprofen, acetaminophen, naproxen, or aspirin in the 72 hours before coming to the ED. The most common reasons patients gave for using pain medications were musculoskeletal pain, headache, and cold symptoms. Of the surveyed patients, 6% reported exceeding the manufacturer's recommended daily dose at some point in the three days preceding their visit to the ED.
Patients who overuse pain medication most likely do so because they have pain that isn't responding to recommended dosages, says Heard. "Almost all of these patients were using the medications with therapeutic intent rather than abuse intent."
The main concern with overuse is that the adverse effects of these medications are dose-related, says Heard. "For example, the risk of stomach ulcers with ibuprofen at 400 mg every six hours is minimal, but the risk with 600 mg every eight hours is doubled."
The take-home message for ED nurses is to identify not only the OTC medications your patients are using, but also the dose of those medications, says Heard. Ask these questions to assess a patient's use of OTC medications, says Robin Scott, RN, ED educator at University of Colorado Health Sciences Center:
- What type of OTC medications are you using? Are you using them in combination or alternating their use?
- How many are you taking per day or for each episode of pain?
- How often are you taking these medications?
- What type of pain or event do you use these medications for?
- How many days or weeks have you been taking this medication?
- Have you asked your regular physician about pain control?
Also ask about blood in stool, dizziness, abdominal pain, blurry vision, nausea, vomiting, blood in vomit, and rash, she advises.
In the study, none of the patients came to the ED because they were concerned about their medication overuse, says Heard. "Most of them were taking the medications to relieve the symptoms that triggered their visit," he says. "In other words, the patients don't tell you about their overuse unless you ask them."
Reference
- Heard K, Sloss D, Weber S, et al. Overuse of over-the-counter analgesics by emergency department patients. Ann Emerg Med 2006; 48:315-318.
Sources
For more information about overuse of over-the-counter medications, contact:
- Kennon Heard, MD, University of Colorado School of Medicine, Division of Emergency Medicine, 4200 E. Ninth Ave., B215, Denver, CO 80262. Telephone: (303) 372-5500. Fax: (303) 372-5528. E-mail: [email protected].
- Robin Scott, RN, Emergency Department, University of Colorado Health Sciences Center, 4200 E. Ninth Ave., Denver, CO 80262. E-mail: [email protected].
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