OTC Pain Relievers: Helpful, Harmful or Both?

In recent years, revelations about addiction to painkillers has shocked the nation and led to legislation to combat what has been described as an epidemic affecting over 12 million Americans.

The drugs in question are opioids, prescription pain relievers such as hydrocodone and oxycodone. But a new study indicates that there could be a price to pay for taking over-the-counter pain relievers as well.

Researchers at Brigham and Women’s Hospital in Boston found in a study of 55,850 women that those who took anti-inflammatories like ibuprofen or naproxen two or more times a week for less than a year, or used them regularly during the six-year period of the study, were 10 percent more likely to report hearing loss. The numbers for acetaminophen (Tylenol) were nine percent, slightly less.

Nor is this the only problem with these pills. Acetaminophen, which is found not only in Tylenol, but also in cold, flu, and allergy medicines, has been linked to higher rates of hyperactivity in children. That’s something to consider if your child gets sick this winter.

Given the extensive and often casual use of these drugs, and the adverse impact that hearing loss can have on one’s daily life, the news forces us to think again about how we deal with pain.

The rethink should be done with the proper perspective, though. Unlike in the case of opioids, addiction is not an issue. Nobody is going out to rob a grocery store in order to finance their Tylenol habit.

This is not the first expression of concern in the medical profession about possible harmful effects from steady use of non-prescription painkillers. While it provides further evidence to buttress earlier findings, it is by no means a shocking revelation. It merely confirms an already existing research trend. So if we weren’t alarmed about it before, there is no reason to be alarmed about it now.

As always, careful attention must be paid to the language of the researchers — and the journalists reporting on their findings. Words like “breakthrough” and “revolutionary” are used with abandon, as scientists and journalists alike strain for headline-worthy material.

In this case, they warn that overuse of these seemingly innocuous products “can have large implications for public health.” Two-thirds of American women over 60 experience hearing loss, and the researchers say they may have found “an important modifiable contributor.”

Note the qualifying terms. It can have, but not necessarily. Important modifiable contributor is medspeak for something that could make a difference under certain circumstances.

The study’s senior author, Brigham’s Dr. Gary Curhan, put it this way:

“Although the magnitude of higher risk of hearing loss with analgesic use was modest, given how commonly these medications are used, even a small increase in risk could have important health implications. Assuming causality, this would mean that approximately 5.5 percent of hearing loss occurring in these women could be due to ibuprofen or acetaminophen use.”

The risk is assessed as modest, but when talking about large populations, every small problem gets magnified many times over. We have to agree: 5.5 percent of millions of people is a lot.

But again, we see the qualifying terms: assuming causality and could be due to. We find ourselves in that shadow land between candor and obfuscation, between the plain admission that we don’t really know yet and the need to justify research work and garner headlines.

We don’t mean to dismiss the story. There does seem to be a real concern here. And even if the research data remains inconclusive, it might be a good idea for those of us who are inclined to treat ibuprofen and acetaminophen as harmless anodynes to cease doing so.

Whatever the actual medical implications eventually turn out to be — if they are ever determined — there are other reasons not to take a pill whenever anything hurts.

While we are grateful for the drugs that are available to make the acute pain of surgery and illness more bearable, it is not healthy to rely on painkillers to make every minor pain go away.

For example, our Sages tell us that the remedy for a headache is to learn Torah. There are two lessons to be learned from this:

We might have thought that the remedy would be to lie down in bed with your head on a pillow and listen to soft music. Chazal teach that the way to deal with such common pain is to ignore it and carry on with your life.

Secondly, the specific activity recommended is Torah. Again, counterintuitive. We think that thinking makes your head hurt and would only make a headache worse. Chazal understood that thinking — Talmudic thinking, at least — makes you forget your headache.

The bottom line should be that painkillers are available, but should be taken judiciously, when you can’t carry on without them.