My good friend called me today after my husband and I had just finished barbecuing on the grill to say that she was up all night with a pain in her tooth like you couldn’t believe.  She didn’t get more than two hours of sleep the night before because the pain was so severe.  To control the pain she took upwards of 10 extra-strength Tylenol throughout the night and I almost died.

I promptly told her that she couldn’t take anymore more Tylenol over the next 24 hours.  Since she was in so much pain I couldn’t fully explain to her that taking so much Tylenol could actually cause more harm than good and that the amount of Tylenol should took could be toxic to her body and cause significant and sometimes irreversible liver damage, so I just told her “no more Tylenol.” 

I realized that the pain must have been so excruciating to disrupt her sleep and so severe that she needed to call me, Dr. Ferguson, so early in the morning.  Because she couldn’t think about anything aside from controlling her pain, I knew I had to find someone to take care of her tooth, immediately, even if it was the 4^th of July holiday.  After a brief search through the yellow pages, I found an oral surgeon who had holiday hours today and could see her immediately.  Within two hours of my first call to the dentist, we were walking out of the surgeon’s office and on the way to her house.

Whether you’ve ever been hospitalized in your life or not, whether or not you’ve ever broken a bone or had a toothache, you have experienced some degree of pain at one point in your life.When you go to the doctor’s office complaining of pain, one of the first things you’ll be asked is to rate your pain on a scale of 1 to 10….one being the least amount of pain and 10 being the worst pain of your life. 

Some of us have a high tolerance for pain—meaning the pain has to be very severe (at a level of 7 or above) before we even tell anyone we have pain.  While others have a low threshold for pain, meaning a pain level of 1 or 2 creates significant discomfort enough that you can’t even function.  To control pain with over the counter medications, you’ve probably chosen from pain relievers such as ibuprofen (Advil), naproxen (Aleve), aspirin or acetaminophen (Tylenol).  All of these over the counter remedies can control your pain but they all have certain adverse side effects that you have to be aware of.

Aspirin is a common pain reliever with a potent and significant effect on your platelets, which are blood cells that are responsible for clotting and preventing excessive bleeding.  Ibuprofen and naproxen are also in the class of non-steroidal anti-inflammatory drugs along with aspirin and also have anti-platelet effects which is why your doctor or dentist may recommend that you discontinue these medications before having major surgery.  BUT REMEMBER….before discontinuing any prescription medication or prescribed over the counter medication, please consult with your physician.

If you are prone to easy bleeding or bruising due to an underlying medical condition, you may want to avoid taking aspirin, ibuprofen or naproxen as over the counter pain relievers unless directed by your doctor.  These NSAIDS can also cause irritation of the lining of your stomach so taking these medications with food may prevent any gastrointestinal upset.  This side effect of the medication is NOT an allergic reaction and should not be classified as an allergy….just an adverse effect. 

Acetaminophen (Tylenol) is in a different class of pain relievers and is useful if you’re already on aspirin because of a prior heart attack or stroke, have a history of easy bleeding or have a bleeding disorder, or have a true allergy to NSAIDS.   Although Tylenol is useful at controlling pain and lowering fevers, it’s not a benign drug.  Taking more than 4000 milligrams or 4 grams of acetaminophen (that’s 8 extra-strength Tylenol!!) in a 24 hour period can be toxic to your liver.  Some studies have shown that even if you take less than toxic levels of Tylenol (less than 4 grams of Tylenol a day) can still have significant effects on your liver, with elevated liver enzymes above the normal range.

I’ve seen people end up with near end-stage liver damage from taking enough Tylenol to control the pain even though they’ve reached and even surpassed the toxic range of acetaminophen ingestion. 

My friend, in her desire and need to control the pain, took too much Tylenol, not because she wanted to but because she didn’t know.  If she had known, she would have called me earlier and we would have gotten her into see the dentist earlier…before she’d taken her 10^th extra-strength Tylenol.   She’s still recovering from oral surgery but it seems that her liver is doing fine….as long as she stays away from high doses of Tylenol.  Not all excessive amounts of Tylenol will lead to liver damage…but it only takes one time—-too much pain, too much Tylenol and too much liver damage.

So the next time you grab that bottle of pain reliever, take a close look at the drug label.  Know how much you should take…know the maximum amount of medication you should take within a 24 hour period and know when to call the doctor if your pain is not adequately controlled.  Don’t wait until it’s too late.

To your wellness,

Dr. Traci Ferguson, The Health and Wellness Queen

This entry was posted on Wednesday, July 4th, 2007 at 11:49 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.