Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

23 Tammuz 5763 - July 23, 2003 | Mordecai Plaut, director Published Weekly









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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

We will continue with evidence based medicine (EBM) in the future, but I wanted to discuss another issue, that of pain relief. Many years ago, and most of us remember this, there was no mild pain relief available other than paracetamol (in the USA called acetaminophen) and aspirin. In Europe, a drug called dipyrone -- also known as optalgin -- was available. Optalgin, to this day, has not been approved in the USA. It can cause shock and can anemia, though there is some literature that says this effect is rare and that this drug may be safer than others currently on the market.

Acamol is the only drug in its class, and it is very effective. It lowers fever and treats pain well and, when combined with narcotics, gives a combination that is more effective than either drug alone. It is safe in the elderly and does not affect the kidneys or cause bleeding.

It is safe in pregnancy and in little children as well. Because it is available without prescription, many people believe it is less effective than prescription drugs. This is just not true. Often it is the best choice for pain. It has no anti-inflammation effects which, as we will soon see, may be to your advantage. An overdose can be lethal. It causes liver failure when taken in massive doses. The correct dose is a question. In children, 15 to 20 mg/kg is safe and effective, while in adults we generally give 1000 mg.

Aspirin is great for pain and has other effects that are helpful as well. It is a very old drug and comes from the bark of a tree in South America. It poisons the platelets -- the cells which control clotting -- so that clotting is slowed. This effect is important to prevent the clotting that can cause a heart attack and stroke. All people over the age of 35 should probably be taking one low-dose aspirin a day. All people with chest pain and heart attack get this drug as well.

It is the cornerstone of treatment in rheumatic arthritis and osteoarthritis, and often these people are on superhuman dosages. It can cause bleeding in the stomach and affects the kidneys. It relieves fever as well, but it has been associated with Reye's syndrome (a serious liver disease) in children with viral infections, and particularly chicken pox. Therefore it has fallen out of use for kids with fever.

Newer drugs for pain came out in the seventies. These drugs, called NSAIDs, were effective pain relievers and fever reducers. They were not overly dangerous in overdose and did not cause Reye's syndrome. The first was indomethacin, also known as indocin, soon followed by ibuprofen and naproxen. These drugs are also sold now without prescription, but the safety factor is still a consideration. These drugs do cause bleeding in the stomach and kidney failure. More next week. Write me in care of the Yated.

A message from GlaxoSmithKline, sponsor of this column. Eczema can cause unrelenting itching, but you may not wish to use a high-powered cream that may have side effects. Betnovate is mild yet effective. Since eczema is often a children's disease, this point is important. Safe for the elderly as well.


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