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Pain Relievers and Hepatitis C

Nicole Cutler L.Ac.

May 10, 2007

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People with chronic Hepatitis C suffer from the same sprains, strains, and body aches as everyone else. In addition, Hepatitis C symptoms can include musculoskeletal pain, joint pain, headache, episodic abdominal pain and liver pain. However, many typical, over-the-counter pain medications can damage an already vulnerable liver. For those with Hepatitis C, finding a way to ease their pain without encouraging liver injury can feel like an uphill battle.

According to a 2005 ABC News/USA Today/Stanford University Medical Center poll, more than 50 percent of Americans live in chronic or recurrent pain. Fortunately, the pharmaceutical industry has provided a variety of solutions to relieve many painful conditions. Despite this, a significant number of people with Hepatitis C who experience periodic or chronic pain are limited in their pain relief options.

Prior to attempting to self-treat pain or discomfort, Hepatitis C patients must discuss symptoms and pain management with their doctors. Because all drugs exert some type of strain on the liver and can also suppress the immune system, a well-informed physician will assess each individual situation and advise their patients appropriately. When living with Hepatitis C, it is a good idea to discuss pain relief medication with your physician as soon as possible so that when pain strikes, you will be ready with appropriate medicine on hand.

Alternatives

Chronic or recurrent pain is typically your body’s way of alerting you that a problem exists. Only attempt self-treatment with alternatives if you are sure your pain is not an emergency. When in doubt, always check with your physician first.

Since every medication taken can jeopardize an already struggling liver, many people with Hepatitis C rely on non-medication options. Before opening a bottle of pills, try these seven, safe alternatives first:

  1. Apply a heat pack on sore muscles, joints or over the liver for pain relief.
  2. Soak in a warm bath with Epsom salts.
  3. Following all directions, rub a natural, topical pain reliever onto the area of pain.
  4. Make sure you have adequate rest. Fatigue always worsens pain.
  5. For muscular pain, gentle stretching or mild physical activity can deliver the oxygen and blood flow needed for relief.
  6. Find a credentialed massage therapist with experience in Hepatitis C and chronic pain. Massage therapy enhances circulation, helping to reduce physical pain.
  7. Some patients achieve pain relief with complementary and alternative therapies, such as herbal medicine, chiropractic or acupuncture. Only seek advice or treatment by a qualified professional, and be sure to discuss any of these therapies with your physician and liver specialist.

Medications

The most common way to manage pain in our society is with over-the-counter painkillers. Also known as analgesics, these drugs may place additional liver strain on people with Hepatitis C. Anyone with chronic hepatitis should discuss the use of analgesics first with their doctor. Always follow your doctor’s suggestions and the manufacturer’s advice when using over-the-counter pain medication. Never exceed the recommended dosage and never combine medications.

The primary over-the-counter painkillers contain acetaminophen, ibuprofen or aspirin. All three of these have some impact on the liver, and can cause liver damage when taken in excess. While occasional, restricted use may be safe for those with Hepatitis C, a doctor will choose the drug based on which is least likely to adversely affect you.

  1. Acetaminophen – (Tylenol, Anacin 3, Panadol, Paracetamol and others) is a common, mild to moderate pain reliever and fever reducer. A liver afflicted with Hepatitis C may not be able to metabolize this drug. High doses of acetaminophen can cause liver injury, even to a healthy liver. In limited dosages, a physician will generally only suggest this class of analgesic to a person whose hepatic metabolism is fully functioning.
  2. Ibuprofen – (Motrin, Advil, Nuprin and others) reduces high body temperature, is an anti-inflammatory and inhibits normal platelet function. A non-steroidal anti-inflammatory drug (NSAID), ibuprofen can cause gastrointestinal upset and bleeding. Those at risk of portal hypertension are already at risk for gastrointestinal bleeding, intensifying this risk. Studies have demonstrated that at certain dosages, ibuprofen can stress the liver and elevate liver enzymes in people with Hepatitis C. Ibuprofen must be used with extreme caution in the later stages of liver disease and for those on interferon therapy.
  3. Aspirin – (Bayer, Anacin, Excedrin and others) reduces fever, relieves pain, and acts as an anti-inflammatory and blood thinner. In addition to influencing liver test results, aspirin’s effect on blood platelets temporarily limits the clotting process and prolongs bleeding. In chronic liver disease where the body’s production of clotting factors is naturally decreased, aspirin can increase the risk of bleeding. Although there is no actual drug interaction between aspirin and the drugs used in interferon therapy, both can disrupt blood clotting, which must be monitored if used together. When taken in high doses (more than 2,000 mg per day) aspirin can cause liver injury.

While relieving aching muscles requires little thought for those without liver disease, it is obviously a complex process for someone with Hepatitis C. Since no one wants to purposefully worsen the condition of his/her liver, having a plan to deal with pain wisely serves people with Hepatitis C. Make sure to discuss your options with your doctor and consider alternatives to medication. Because many people with Hepatitis C experience pain at one point or another, experiment with the seven alternatives listed above. If you are lucky, you may not need analgesics after all.

References:

www.hepatitismag.com, Balancing Act: Drugs that can Help and Hurt, Jason E. Moore, hepatitismag.com, 2007.

www.hepatitis-central.com, Hepatitis C & Drug Use, Hepatitis-Central.com, 2007.

www.hepcawareness.net.au, Pain Management, Australian Hepatitis Council, 2007.

www.hcvadvocate.org, A Guide to Hepatitis C Treatment Side Effect Management, Hepatitis C Support Project, 2007.

www.medicinenet.com, Common Cold, William C. Shiel, Jr., MD, FACP, FACR, MedicineNet, Inc., 2007.

www.medicinenet.com, Pain Poll: Many Americans in Pain, Miranda Hitti, WebMD Inc., 2007.

www.pkids.org, Ibuprofen vs. Acetaminophen: Which Painkiller is better for Children with Viral Hepatitis?, Thomas R. Riley III MD, Jill P. Smith, MD, Parents of Kids with Infectious Diseases, 2007.

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Posted by Nicole Cutler L.Ac. on May 10, 2007

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  • amanda

    I am going crazy i have hep c but dont know what to do ont have a dr yet dont know anything about it can anyone help. EMAIL. Melvin.O.Argueta@gmail.com thank you i am amanda

    • angelo212

      You got to be kidding me. Here you are on the internet and you can’t find any info on hepatitis c or a doctor? You have more problems then you think. Not to mention you just gave your email address to millions of people who will SPAM the hell out of you. Your in it really deep baby girl. If your in the New Jersey or New York area reply back.

      • Rebecca

        No reason to be mean. Doctors can be easy to find, but good doctors may be what she’s referring to.

        • BABYGIRL

          AND YOUR RIGHT REBECCA GOOD DOCTORS ARE VERY HARD TO FIND

      • Tucsondee

        Angelo go do something kind for someone today! Dee

    • Tucsondee

      Just saw this and emailed you. If I can help in anyway key me know. I have gone through 4 treatments with no success. There will be a new drug coming out in 2014 without interferon. In the meantime there was a study in Boston about drinking grapefruit juice. I drink Florida natural, not from concentrate. I no longer have fibrosis or a fatty liver. So email back and I can help you with dealing daily with hep c.
      Dee

      • bobbie

        i have no insurance but need treatment to lower hep c viral load so i can have surgery

      • thestoneangel

        New info on grapefruit juice. It can cause liver toxicity due to the enzymes not breaking down the meds properly. Many deaths reported with heart meds building up and causing a system overload that is fatal to many. Check out the current info. On several of my pain med bottles it warns not to take with grapefruit juice. The Stone Angel

  • Guest

    Great. I can stay in pain for I dont know how long until someone makes up their mind and what will be best (even the least offensive would be nice).

    • thestoneangel

      Pain mgmt was a God send for me. They have made life bearable and I’m out of bed and the fatigue and pain is not gone but down where I can function. On the pain scale, a 3 is wonderful to me! The Stone Angel

  • Patti

    they have a new treatment med coming out next year, The new one for last year I was only able to do for 14 wks, and had to have a blood transfusion. It is now detectable again. I am going to try again next year. they have programs to pay for the meds and if you have insurance they will pick up the rest of the money you need to get them.

    • samantha

      My sister has hep c and she doesn’t have insurance, is there a link to a web page that I can have so she can get help getting the treatment etc that shes needing….

      • bobbie

        did your sis find help

      • thestoneangel

        Clinical trials are becoming more and more available for HCV and HBV. There is a specific website to sign up on and receive emails when you find a match for your condition. Worth checking out! The Stone Angel

      • Patti Schrimscher

        read the post I made to thestoneangel. It was meant for both of you

    • thestoneangel

      I have heard some about this new treatment. I was under the impression that it cost around $50k for one week of meds. True or not? I’d like to investigate more, even though after 25yrs, I have resigned to acceptance. Not to be confused with giving up!

      • Patti Schrimscher

        After the Dr. agrees with the type of treatment she needs then they should help with different drug companies to help her. There are different types of Hep C. You can also google assistance with Hep C meds and the companies should have application on their website to print and fill out. Then you have to be approved which she will if she doesn’t have insurance. It would be considered a hardship request. One of the companies that help is
        Bureau of Prescription Health.I hope this helps her.

  • Patti

    there is also a pain cream you can use called Voltren. It’s by prescription only and the Dr. usually has samples to try before getting it at the drug store.

  • Unlucky girl

    So basically they don’t prescribe anything for the pain I will be in

    • thestoneangel

      Get a referral to pain mgmt. Their job is to not let you suffer in pain. Also, never take OTC pain meds, they make you feel worse than you could ever imagine. Put in your med records that you cannot take Tylenol, Motrin, nsaids, or aspirin. You need a more pure form of pain relievers, without the added risk to making your liver more toxic. Even though HCV/HBV can take over 30 years to show symptoms, recently a friend that had no symptoms, out of the blue, spit up blood and passed away in the ambulance on the way to the ER. You just never know, there is no predictable time table on this silent virus. It’s constantly attacking you from the inside, even with completely normal liver panels, your body is at risk and fighting an unseen battle. Your only indication that you carry HCV and/or HBV, like myself, is the pain and fatigue that will eventually come like a thief in the night! Stay strong and God bless! The Stone Angel

  • nick

    yes there is…Jackson menorial in miami, put me on oxycodone, they said will help with the pain and not effect the liver

    • thestoneangel

      I totally agree. I also take Roxicodone(Oxycodone), and MS Cotin(Morphine). After 25 yrs my pain and fatigue hit me super hard without warning. I feel no shame taking pain killers, they make it bearable for the fist time. Btw, never any OTC’s they cause more liver failure than alcohol and will cause you more problems than you ever thought possible. As far as pain meds not effecting the liver, everything you put in your mouth(system) effects your liver, just at different levels. Compromised livers cannot handle what healthy ones can. Liver toxicity has a greater risk of happening to a HCV/HBV patient. Also, natural herbals, vitamins including iron, holistic remedies have not been approved by the FDA to be safe for people with liver disease. The best thing we can do is inform our selves, become a doctor if necessary. Nobody is going to care about your health and pain like you will!

  • thestoneangel

    I agree that doctors willing to tackle HCV are rare. I am not a candidate for the ribo/interferon therapy so most doctors have told me to just live with it, (or rather die with it). I have been symptom free for 25 years then a year ago symptoms hit with a vengeance. The worst being debilitating fatigue and all over joint pains. A pain mgmt doctor advised me that I don’t have to just deal with it. Since it’s killing me anyway, I want to be as comfortable as possible. I am currently taking Roxicodone and MS Contin. Now I have my life back, I’m up and out of bed, not suffering anymore and I have no problem being on pain killers if they improve the quality of my life. Don’t be scared to feel better, you deserve to live life to the fullest while you can. Having this virus is stressful enough, but suffering with the symptoms can make not only your life difficult, but watching your loved ones go through this with you is the worst pain of all. This is a disease that effects the whole family, and talking about it with your children is necessary but unbearable to see the pain in their faces. All the research and support groups in the world won’t take the HCV away. Just remember that there are millions of us that suffer in silence. Today I don’t want a cure for this disease, it does not define who I am, I am here dealing with this on my own terms. My cross to bear, take care of your health, you only get one shot sometimes! Doctors will say that love does not cure illness, but love does cure the broken hearts, that people with HCV and HBV live with everyday. Btw, Tylenol and Motrin cause more cases of liver failure than alcohol toxicity. If I’m misinformed, please look this up, valuable info to know!

    • Courtney Campbell

      How easy was it to get a referral to pain management? Because my joints are killing me everyday!! And my hands are constantly swelling

    • irishlakegirl

      What a great rely. God Bless You and your family!

  • BABYGIRL

    I went to my doctor yesterday and she said she was going to give me oxy then before I left she said no I want you to go to the hospital right now because your lungs don’t sound good ( I had been very sick for a whole month ) I call the hospital and they’ give you something there to take home the pain and you kno I was in the hospital for 13 hours and they didn’t send me home with nothing then today I call my doctor and tod her they didn’t give me nothing for pain and she says ok well I can give u some tramadol I told her that the tramadol doesn’t help at all with my pain

  • irishlakegirl

    totally useless article

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