In search of painkillers that don't damage the stomach

I’m pretty sure I gave myself ulcers by taking Aleve. Sometimes I’d take two a day for days in a row to cope with stomach pain and severe menstrual cramps. I just sort of noticed this connection last night, when my stomach hurt, I popped an Aleve and immediately got sicker. The problem is that Aleve is one of the few OTC painkillers that helps with my stomach pain (yes, I’ve seen a gastroenterologist, and no, there’s nothing seriously wrong with my stomach. It just sucks as a general rule.)

So what can I take for stomach pain and severe menstrual pain that will not make my stomach problems worse?

COX2 inhibitors (like Celebrex) were designed specifically for this reason, but they’re only available by prescription, as far as I know. Also, ulcers are caused by a bacterial infection, but that’s a side issue.

So taking Aleve couldn’t have contributed to the development of ulcers?

Probably not, but that doesn’t mean it can’t exacerbate the symptoms.

Tylenol (acetominophen). That’s all. I’m sorry, I know it doesn’t work, but it’s the only OTC painkiller that’s not hard on your stomach.

Also, not all ulcers are caused by the H. Pylori bacteria. Mine isn’t.

Taking Aleve could have contributed to an ulcer, but if your gastroenterologist says you don’t have one, you probably don’t.

Somepeptic ulcers are caused by use of OTC painkillers.

When I needed to take a lot of advil for dental pain (several times daily at prescription strength for 6 weeks) my dentist told me to never ever ever ever take it on an empty stomach.

Are you sure it’s ulcers, or are you using the term loosely?

NSAID use is associated with ulcers, non-steroidal anti inflamatory drugs include motrin/advil, aleve and aspirin, all are know to irritate the stomach.

Tylenol is the only over the counter, doesn’t affect you from the neck up, non stomach irritating anagesic I know. It doesn’t work very well for inflamatory pain, though, such as twisted ankles and arthritis.

A major causative factor (60% of gastric and up to 90% of duodenal ulcers) is chronic inflammation due to Helicobacter pylori that colonizes (i.e. settles there after entering the body) the antral mucosa. The immune system is unable to clear the infection, despite the appearance of antibodies
Another major cause is the use of NSAIDs (see above). The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins

the whole article

I wound up in the ER about a month and a half ago with severe stomach pain, but I was on Nexium for over a month by the time the doc got to see inside me. He found only inflammation. He theorizes that I had ulcers that were healed by the Nexium. This fits because I did have a hernia in my esophagus when I was 16 and it wouldn’t surprise me if my ebbing and flowing abdominal pain over the last several years could be attributed to the effects of acid reflux combined with this medicine that tears my stomach apart.

I take Aleve on an empty stomach all the time because I have to skip meals in order to avoid getting sick in public. I’ll try Tylenol.

There are only a couple OTC pain releavers out there, and most of them are NSAIDs (Naproxen[Aleve], Ibuprofen[Advil, Motrin]), and then there is acetaminophen (Tylenol). All the NSAIDs can cause ulsers, acetaminophen doesn’t. The only major problem with acetaminophen is liver toxicity, but as long as you have a health liver (aka, don’t drink a lot, doesn’t have Hepatitis) and don’t take more then 4000mg of acetaminophen in 24hrs it is safe.

Also, most ulcers are caused by H. Pylori, only about 20% of ulcers are caused by NSAID use.

Wait a minute, wait a minute.

First, the disclaimer. IANAD is not a little-known kind of mythological nymph.

All NSAIDs (non steroid anti inflamation drugs) list messing with your belly as part of their possible side effects. That doesn’t mean they all will mess with your individual stomach, nor does it mean that if one messes with your stomach, they all will.

The only way for anyone to find out is to try several, and use the one kindest to your own stomach. Aleve® (naproxen sodium) gives some people bad bellyaches, but for me, it’s the most belly-friendly NSAID. For others, it’s ibuprofen, aspirin, or Tennessee whiskey. You must do your own research.

With a little Yahoogling®, you can find the official website for any drug. You can read the whole “fear sheet,” with not just the possible side effects, but what percentage of patients got them. It gives you some perspective to find out your odds of getting drowsiness, rashes, loss of fingers, hallucinations, death, diorama, or bellyaches.:eek:

IAAD, and I would advise folks with active GI symptoms to avoid all NSAIDS (including COX II like celebrex) until they’ve consulted with their doctor. There are no ‘safe’ NSAIDS for people with a propensity to gastric bleeding.

And the degree of symptoms one has or doesn’t have on a particular NSAID does not necessarily correlate with what’s really going on in one’s stomach. I’ve had patients tell me naproxen doesn’t bother their stomach, only to have them nearly bleed out from gastric erosions.

Isn’t it true that taking famotidine with ibuprofen can protect the stomach from developing ulcers? Also true that famotidine can cause problems when taken with naproxen because it causes the enteric coating to dissolve too quickly?

So, be careful about any meds taken together, call your doctor first. But maybe if ibuprofen works better than acetominophen, make sure to take famotidine on that empty tummy too.

I had a duodenal ulcer last April and lost half my blood volume, requiring emergency endoscopic surgery to repair what my gastroenterologist called, “a crater on top of an artery”. I was negative for H. pylori, the virus associated with ulcers, and he attributed my ulcer to my use of Aleve. I took two tablets before bed for my carpal tunnel pain, maybe 3-4 nights a week. He said that would do it.

I was told I could take Tylenol for pain, but pretty much nothing else that was over-the-counter.

ETA: I had no stomach pain while using Aleve, nor when my ulcer perforated. I was totally surprised he told me I had an ulcer.

Proton pump inhibitors (a la omeprazole) are generally recommended for prophylaxis of NSAID-induced gastritis. H2 blockers (like famotidine and others) may also be helpful, but the data is better for the former class of medication.

And it’s no sure prevention either. I’ve seen folks get GI bleeding while on famotidine and omeprazole.

This is some really scary stuff. So the people I know who just “ride it out” and refuse to take OTC painkillers are really not so far off. I’ve always been in the “just take a pill once in a while” camp, but now I’ll think twice. Naproxen has always been my NSAID of choice because it works really well for me, but I think I’ll be springing for the ol’ acetominophen in the future!

Thanks for this very valuable info.

My Dr. told me that data showed COX-2 drugs only helped for a short time. After about 6 months they were no better for your stomach than other drugs. Of course not many knew about this when they took them.

I would check with a doctor on this point. My understanding was that liver toxicity can build up over time if you’re taking it consistently for weeks on end.

So what do we do if we have a history of acid reflux but need anti-inflammatories?

This has come up for me recently, too. I’m trying to get some inflammation in my knee down so the PT can work on it. I also have a history of carpal tunnel and other inflammatory pain.

Acid reflux is not the same thing as gastrititis. So having reflux doesn’t necessarily increase the risk of NSAID-induced gastritis. One should check with one’s doc about whether one can tolerate NSAIDS based on one’s symptoms.

I needed a root canal and before I got it I took a lot of ibuprofen. After a while I could tell it was giving me a stomach ache. When I cut back my stomach was OK.