Not so long ago, an arthritic knee or a sore head had to be endured, endured, with no options for pain relief. With the advent of modern pharmacology and the rise of the pharmaceutical industry, it would appear that we now have countless options for reducing pain. Browse the aisles of any drugstore and find shelf after shelf with a multitude of products. But a closer look will reveal something interesting: Only a few choices exist for over-the-counter pharmaceutical pain agents.
Naturally, our culture favors choice, so there are many products for mild to moderate discomfort. Although they may all have different names, the important ingredients consist of only 3 or 4 pain relieving substances. As most would guess, the first of the current generation of off-the-shelf pain relievers is that famous, much-advertised household product aspirin. The word itself, once a proper word, a brand name, like Kleenex or Tylenol, was capitalized. It is now part of the lexicon, of everyday, colloquial language.
It is a pharmaceutical agent with a rich history of development and deployment. It was at the turn of the 19th century that the analgesic and the antipyretic (antipyretic) were introduced. Felix Hoffman is the chemist who developed the specific substance acetysalicyclic acid, often referred to as ASA. Aspirin is one of the best studied drugs in the world.
It is classified as a member of the group of nonsteroidal anti-inflammatory drugs, NSAIDs, such as the popular ibuprofen (Advil, Motrin) or naproxen (Alleve, Naprosyn). The word itself is a combination of some of the components of the chemical that is aspirin. It has been used for a variety of its effects, from preventing clotting to the aforementioned reduction in fever. These, in addition to the famous pain relief.
The substance that makes aspirin effective is mainly salicylic acid. It has been used medicinally in various forms since ancient times. One common method has been to use willow, a leaf that contains the natural compound from which aspirin is made. The use of the willow leaf appears medicinally in the clay tablets of ancient Egypt. Herbal tea was used by Hippocrates to relieve the pain of childbirth around 400 BC. This chemical, salicylic acid, the basis of aspirin, was first synthesized in 1853 by a French chemist.
Perhaps most important in recent years is aspirin’s ability to alter the coagulation cascade, the natural process leading to the formation of a blood clot, like the scab that forms when a finger is cut. . Due to this action, a few years ago, the recommendation was made for people over 50 at higher risk of stroke or heart attack to take low-dose aspirin daily. For years, millions of Americans have followed these guidelines consistently and over the long term … sometimes to their detriment.
How aspirin works like blood “thinner” (although this does not change the thickness of the blood at all). It slows down coagulation by making the blood cells responsible for forming a clot, the platelet, less sticky. Reducing the likelihood of a clot forming in one of the vessels leading to the heart decreases the risk of a stroke. But it does mean that the bleeding may not stop in a timely manner where and when it is needed. Stomach bleeding, in which there is (hidden) blood loss in the stomach cavity, results too often.
Like just about all medications, aspirin has a variety of potential side effects. Some of the ill effects of the drug include irritation of the stomach or intestines, nausea, vomiting, or stomach cramps. There are others, more serious, less frequent. But the benefits of reduced clotting are also integral to its dangers.
After much study, the tide has officially turned over the past decade. Even this august body, the conservative American College of Cardiology, changed its stance on the subject, issuing a statement in 2019 that people over 70 should not routinely take aspirin daily. The explanation is that the risk of gastrointestinal bleeding is too high compared to its benefits.
This is great news. Many individuals continued to practice a daily aspirin, believing that they were doing themselves good. On the contrary, long-term use of aspirin can have serious consequences. Don’t assume that a medical practice described as beneficial by a neighbor or relative will be good for you. New evidence is coming to light, more definitive studies are being done every day. Medical advances are made, new recommendations are made. But be careful where you get your medical advice. Dr. Google doesn’t know your medical history … and doesn’t care.
Editor’s Note: Dr Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now in Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally and written dozens of articles on wound care, surgery and diabetic foot medicine. He is board certified in surgery, wound care and lower limb biomechanics.