Chronic Pain Patients Overusing OTC Meds

Chronic Pain Patients Overusing OTC Meds

By Ed Coghlan

Dr Byron Cryer

Dr. Byron Cryer

American chronic pain patients who take over-the-counter (OTC) medication are routinely ignoring medicine labels. Physician and consumer surveys released by the American Gastroenterological Association indicate that this practice is putting people at risk of overdose which can lead to serious side effects.

“Pain is incredibly personal, but taking more than the recommended dose of OTC pain medicine can cause significant stomach and intestinal damage among other complications,” said Dr. Byron Cryer, who is councillor-at-large, AGA Institute and association dean of the University of Texas Southwestern Medical Center in Dallas.

Some of the serious side effects include stomach bleeding, ulcers, liver damage and even death. AGA commissioned the survey entitled Gut Check-Know Your Medicine which was featured on the National Pain Report in September.  1015 US Adults over 30 and 251 gastroenterologists took the online survey.

Key findings include:

  • Many specialists report a majority of their chronic pain patients are using medicines at a higher dose and for a longer duration than recommended and often don’t connect the overdose symptoms to their misuse.
  • 43% of chronic pain sufferers said they knowingly have taken more than the recommended dose at some point.
  • The same number report that they consider the directions on the labels are just guidelines and that the patients know what works best for them.
  • 38% reported not knowing that combining two or more nonsteroidal anti-inflammatory drugs (NSAID) pain reliever or two or more acetaminophen produces increases the risk of serious health complications when taking OTC pain medications.

Another interesting statistic in the survey was the revelation that many self-described chronic pain patients report they aren’t seeing a pain specialist. Only 12 percent reported seeing a specialist while 2/3rds of them report having had chronic pain for two years.

The survey was conducted by Harris online in the first week of October, 2015.

Gastroenterologists report that a vast majority of their patients who either take higher than recommended OTC doses or use the medication longer than recommended are chronic pain and/or arthritis sufferers.

“It’s a growing problem because people living with chronic pain and taking multiple medicines often don’t recognize the side-effects of taking too much,” said Dr. Charles Wilcox, professor of medicine at the University of Alabama at Birmingham.

The AGA educational campaign called “Gut Check-Know You Medicine” can be found here.

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Authored by: Ed Coghlan

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I had a bike accident in 2003, developed shingles from that, almost died, but then came PHN, no cure,. I have taken Lyrica for years and somedays its manageable, somedays not. I’ve tried nerve blocks, acupuncture, OTC meds, now I live with the side effects of swelling, IBS, etc. I don’t even talk about it anymore, it is truly life altering. People who live with chronic pain are WARRIORS. Bless you all.


Part of the issue is that opiod drugs are being demonized. When I was first prescribed Tramadol, I tried to just take one pill per day, even though I could take two according to the doctor.

I thought I was being “good” if I tried to avoid taking more tramadol. So, I took Tylenol (before we knew that tylenol could be so damaging to the liver). I followed the package instructions, but I was taking it regularly.

I then developed an awful headache. I couldn’t lift my head off the couch. I called the rheumatologist in tears, wondering what was happening. She asked if I was taking OTC meds, and I told her. She said I was probably having an “analgesic headache” (also known as a rebound headache).

Basically, some meds bite back if you take them regularly. Pain medications may cause headaches…

She advised me to take my tramadol as prescribed (which controlled my pain and negated the need for tylenol). She told me not to try to take less… but to take it if I need it (still sticking with the prescribed dose of course).

Some people think OTC is harmless and they try to manage chronic pain that way. This is pain that sometimes would much better be managed with visits to the appropriate doctor and with the appropriate PRESCRIPTION medication. Y’know… the stuff that’s MEANT to be used for the purpose of treating chronic pain. Y’know… the stuff that is getting harder to get prescribed because of the pressures of medical boards and the DEA scrutinizing doctors who are still prescribing responsibly.

Prescription painkillers definitely have a purpose. I found that out. I’m still wary of how much I take, but if I need it, I take it. I communicate with the doctor if I’m struggling and we talk about options.

It’s very distressing to me that people who need medications may no longer have access to them. I did submit a comment before the January deadline. I pray we’ll be heard.

Kristine (Krissy)

Donna and Michelle – same here. I need a procedure and I need a dentist, podiatrist, rheumatologist and an ME/CFS specialist. Instead of going to see them, because of the money, I got an Rx for a wheelchair. That is not right — I feel like my healthcare is completely out of my control. That’s why I will only vote for Sanders. (Not to start a political conversation please :)).


Michelle, you speak the truth. I have had 2 epidurals years ago. The pain specialist wants me to have them again. I do not have the money for 300 dollar deductible for an MRI and a 300 dollar deductible for an ESI. I just dont. But they put in my record as a refusal. They are extortion us. This shouldn’t be allowed. Yet it is. Once again, chronic pain patients can be marginalized and made to feel like criminals. I am so bitter, and I feel you are, too, Michelle. I’m so sorry you are going through all this.


And what of the cost for pain management? How can a Dr. Who oversees compassionate care charge $200.00. every month? To one he knows is uninsured. And can’t afford a procedure that will only temporarily elevate one of your meny chronic pain prognosis. Then after 6 or so months, a nurse tells you; if you can’t cough up the cash for the proceedure we May just let you go!. How can this happen? Even with DEA down everyone’s throat, this is ludicrous. I can’t work I can’t even afford to be sick. All this is too too much! I understand why chronic pain sufferers give up. I really do!

Nana Mayer

I am a chronic pain sufferer with gastritis but I am one of the lucky ones. My doctor prescribes me an opioid and helped me find a good dosis and it changed my life. I am still on multiple meds and there is still pain but not strong all day everyday. I still cannot work. But if I need to function for one of my kid’s school events or birthdays, I know I can commit to doing it. I no longer have to leave the room when the kids dance or sing loudly.
I wish more doctors could take the time to get to know their patients enough to recognize pain and then prescribed whichever medicines they need. Opioids are not damaging to internal organs and intact delayed-release formulations have an extremely low probability of being habit-forming. They should be on the table for everyone suffering from pain.

Scott michaels

Tell your story.
Theyre not pain killers, theyre pain relievers. Thats why we need them every day!

Kristine (Krissy)

I used to take what is now Aleve when it was a prescription for RA. Like the other RA drugs I took, it eventually stopped working. I went on to take Gold, then added aspirin. I took aspirin, Tylenol and Ibuprofen for years. Eventually I got an ulcer. A year later I went back to the wonder drug — aspirin — on top of 800mg Ibuprofen, and an opioid. Finally the aspirin caused me to bleed just by touching my skin and it made me very nauseas. It also wasn’t working anymore even at four pills per dose. I quit taking it altogether, but it was the wonder drug for a long time. I wouldn’t touch aspirin nor Tylenol now for a million bucks. But I do take 800mg of Ibuprofen every six hours, three times a day and it helps me a great deal. I am on two opioids with that. My condition has worsened a lot, but I don’t want anymore medication!


I see a pain specialist that lowered my pain medicine from my now-retired primary doc. They then added 800 MG of ibuprofen three times a day and told me I could take 3000mg of Tylenol per day. I take prednisone daily for asthma, have reflux and IBS. Pain still out of control, and then stomach pain on top of that. I also take pravastatin, so no telling what my liver is like. I keep complaining and then they have the nerve to jump my back because I was ACTUALLY TAKING THE IBUPROFEN AND TYLENOL AT THE DOSES THEY TOLD ME. So I get a teeny increase in opioid med, told to stop the other. I still hurt, and now they threaten me with stopping opioid since I still say I hurt. Pain specialist? Worst thing ever to happen to me, but docs don’t write scripts or even see you if you have chronic pain. How is this allowed? Why is it okay to discriminate against us? Can we sue? Wish I knew.

Lynda Richardson

If chronic pain patients could get the pain medication they need to relieve their pain.We wouldn’t need to take OTC medications or need to take more then one kind of OTC. If chronic pain patients weren’t criminalized & discriminated against. Chronic pain patients wouldn’t have to take OTC medications at all or in too high of dose or mix OTC in search of some sort of pain relief if the pain was being relieved. Everywhere chronic pain patients turn especially now with the all out attack on pain medications chronic pain patients hit a brick wall. Doctors, nurses, pharmacists and the public only see drug seekers, addicts and abusers. Instead of treating the person in front of them you instantly become the addict abuser committing diversion at every turn Because of it all being so blown out of proportion. The falsehoods and discrimination of chronic pain patients are going under treated and untreated and some won’t even try to get help or have nothing else to relieve their pain. Chronic pain patients had it difficult to get adequate care before. Now it’s almost impossible. Thanks to certain agencies and the media for making every chronic pain patients life that much more painful.


PS – When, as a chronic pain patient, you have no other alternatives/are denied much needed care, you are relegated to OTC drugs.How are these doctors/specialists NOT aware of this? They are, in fact, causing the problem.


I recently called several Pain Specialists to set appts., intending to get a “team” of providers together as suggested by my GP of 18 years. Once I mentioned Fibromyalgia or ME/CFS (*Note: I also have long term back and neck injuries), the first thing out of their mouths has been “Dr. X does not prescribe/do pain medications”. This has happened repeatedly with PAIN SPECIALISTS. I have not even gotten farther than my name/condition and been denied! BTW – I rarely take pain meds, unless I really need them (ie. when I wake up crying from the pain – historically aprox. 1-2 days every 6 mos.), and clearly have not abused them at any time.

At what point does denial of ANY/ALL opiods to (monitored, clearly non-abusing) chronic pain patients become REFUSAL OF CARE? While I understand the Hippocratic Oath is not “legally binding”, isn’t NOT helping when you CAN help a violation of “Do No Harm” and it’s implied code of ethical standards?

The patients these medications were meant to help/created for need access to them. Simple logic must come into the discussion/be applied at some point.

When my pain specialist cut my opiate medications by almost half about a year or 18 months ago because of the new guidelines, I tried taking more than the recommended dose of aspirin to help with my pain. Unfortunately, my kidney function is not the best, so I had to stop taking aspirin and other OTC meds. I think you will find that most of this phenomenon is caused by inadequate pain management at the physician level, because the physicians are worried about getting in trouble for prescribing too much opiates. My pain specialist has an article on the wall in every one of his treatment rooms about a doctor who was charged with murder because of over prescribing opiates. I think that says a lot.


I believe that Kate Lamport summed it up nicely. I know of many chronic pain patients who can’t get in to see a pain management doctor. If you’re untreated or even under treated, which is also happening to many chronic pain patients, the only alternative they feel that they have is to take OTC pain medication at higher doses. It’s really a lose/ lose proposition for many chronic pain patients. Maybe if chronic pain patients were being treated properly throughout this country, this wouldn’t even be an issue.

I agree with Kate Lamport,you either can’t be seen by a Pain Doctor or they’ve cut our medicine for pain so far back that we are left without a choice,,I’ve had to take over the counter pain Meds because I’ve become so desperate that I would have eaten doggy doo to try and alleviate my pain.
I had to go to the emergency room a couple of times because I was throwing up blood,,they put a tube up my nose and down my throat trying to help me,,All I can say is that when your in so much pain and there’s no relief in sight you will eat or try anything to get rid of the pain!!
Now on top of not getting our Pain relieved ,,we are also being treated like criminals ,, we are being verbally abused and dehumanized as well as being tormented with laughter and stare downs at the CVS s and Walgreens of the world.
When your pain is not validated along with being treated like you don’t matter in life,,Some of us will revert to ending this demoralized Existence., who cares anyway,,we’re tired of fighting to be heard and Validated in a world where we don’t matter,,it’s being put forth like the world is trying to Protect us from the Doctor prescribed medicines when instead the bigger agenda that the CDC ,,DEA,, and the FDA are putting into effect to protect themselves from their Own Failure on the Drug War that they know will never be won on the backs of all us!!! The People !!who are fighting a War of our own,,
This is no less than Genocide by Our Own Government that’s making us suffer,, withering in Pain and being treated like no less than garbage ..Paula Lopez


How about drs help treat chronic pain properly and safely and help us chronic pain patients advocate for their ability to do so. This way patients will not self medicate.

Kate Lamport

Many are not seeing a chronic pain specialist because they cannot get into one, hundreds of thousands of “self proclaimed” chronic pain patients are falling through the cracks. Of course they are going to take more than the recommended dose!