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Pain Relievers and Hepatitis C

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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.

It was estimated in a recent Centers for Disease Control and Prevention (CDC) report, that 50 million Americans have chronic 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.


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 salt.
  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.


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 (as little as just twice the maximum recommended dosage) can cause liver injury, even to a healthy liver. While you might not be taking acetaminophen in high dosages by itself, it is important to remember that it is included in many other over-the-counter medications and some prescription medications for colds, headaches, sinus congestion, etc. 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.
  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 interferon, both can disrupt blood clotting, which must be monitored if used together during combination therapy. When taken in high doses of 1,800 to 3,200 mg daily, 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.


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Doerr, S., MD, & Gompf, S., MD, FACP. (2018, December 3). Common Cold Treatment, Causes, Stages, Symptoms & Prevention (W. C. Shiel, Jr. MD, FACP, FACR, Ed.). Retrieved December 19, 2018, from

Porter, L. K., RN, & A. F. (n.d.). A Guide To: Treatment Side Effect Management: Interferon-Based Therapies. Retrieved December 19, 2018, from

Porter, L., RN. (2016, January 21). Hepatitis C and Pain, Part 1. Retrieved December 19, 2018, from

Riley, III, T. R., MD, & Smith, J. P., MD. (n.d.). Ibuprofen vs. Acetaminophen: Which Painkiller is better for Children with Viral Hepatitis? Retrieved December 19, 2018, from


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