RISKS ASSOCIATED WITH CHRONIC PARACTEMOL USE FOR CHRONIC PAIN IS IT SAFE


For many Brits, taking paracetamol is part of the daily routine. Whether it’s swallowing a couple of pills before bed when a headache comes on, taking them to mask period pains, or to avoid a dreaded morning hangover. Research demonstrates that 1 in 8 Brits are reliant on paracetamol and take it everyday.

Paracetamol is currently marketed as an analgesic and antipyretic, to be used for no more than 3 days without consulting a doctor . However, due in part to its inclusion in the WHO analgesic ladder, as well as decades of clinical experience, it is also prescribed in chronic conditions such as osteoarthritis and lower back pain
Concerns have been raised over the effects on the cardiovascular, respiratory, renal, gastrointestinal and central nervous systems

Studies also reveal the amount of paracetamol Brits consume is far too high, as 1 in 4 frequently exceed the maximum daily dosage of paracetamol, which is 8 tablets.

Approximately 25% of Brits experience chronic pain, however, evidence shows there are some extremely damaging side effects of long term painkiller use.

1. Liver failure

“Liver injury can occur with regular paracetamol intake, at or below the recommended daily dose, which is one or two 500mg tablets at a time, up to four times in 24 hours with a maximum of eight tablets in 24 hours according to the NHS.

“Studies have shown that paracetamol can damage the liver by harming vital structural connections between adjacent cells in the organ.

“In fact, unintentional overdose of paracetamol is the most common cause of acute liver failure in the UK and US4. In 2021, 227 deaths in England and Wales were due to paracetamol overdose as a result of liver failure.”

Recent epidemiological studies have identified a potential increased risk of upper GI bleeding with doses of paracetamol ≥2–3 g d–1.When combined with NSAID, the risk increased to 13.2 (9.2 to 18.9), indicating a substantial interaction

2. Heart attack

“Studies have shown that regularly taking paracetamol that contains sodium is linked to an increased risk of heart attack, stroke, heart failure and death.

“Sodium, which is one of the main components of salt, is often used to help drugs such as paracetamol dissolve in water.

“However, if a person takes the maximum daily dose of paracetamol, they would also be exceeding the 2g maximum daily dose of sodium. Research shows that regularly taking paracetamol containing sodium over a long period of time, can massively increase a person’s risk of heart attack, stroke, or heart failure, regardless of whether they have high blood pressure or not.”

One such study was a placebo‐controlled crossover study of 20 treated hypertensive patients, in whom a 4 mmHg rise in blood pressure (BP) was found when paracetamol was administered .
Given that a 2 mmHg rise in systolic BP is associated with a 7% increase in the risk of ischaemic heart disease and a 10% increased risk of stroke,his apparently small increase in BP could have serious population‐based consequences.

3. Respiratory problems

“Research shows that frequent paracetamol use can lead to a significant increase in the probability of wheezing.

“It is also associated with an increase in asthma symptoms, and the effect is greater, the more the drug is taken.”

4:Tiredness and fatigue

“One of the most frequent side effects of paracetamol is exhaustion and fatigue, due to the acetaminophen content of the drug.

“If it is taken regularly, then it’s likely a person will regularly feel tired and drowsy more of the time.”

Whether paracetamol use in the chronic setting should be restricted is doubtful, given that the alternatives are NSAIDs and opioids. Indeed, in patients intolerant of NSAIDs, their next option would be opioid medication, which comes with risks of addiction, drowsiness and fatal accidental overdose.