Endometriosis UK
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Painkillers and long term effects on the liver

Hey so I was wondering if you ladies are taking painkillers do any of you have problems with your liver / or think you may do?

I was wondering because a few years back, when was taking lots of paracetamol for period pains, I had a liver test and a liver ultrasound which docs said I had an enlarged liver due to the painkillers. They said if I reduced the amount I take the liver problem should resolve itself. I've been taking less until about a year ago when the period pains got really bad (now I know it's endo) when I've needed to take more as work need me to be in. I'm currently on just ibuprofen and paracetamol together for four to seven days around my period, so I can manage the pain and be in work. But am worried about how all this will be broken down and affect my liver?

Is it just paracetamol that's really bad? I don't want to go to the gp for my pain to be given stronger ones that could be worse. Do you think I could ask for regular liver tests?

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if you are worried have you looked into taking milk thistle when you take the meds to support your liver? x

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I hadn't thought of that, I shall have to look it up and research into it. thanks x

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Ahh it says it can mimic the effects of oestrogen so it is suggested to be avoided by women with fibroids or endometriosis :(

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Hi, it’s a good question. I get occasional dodgy liver test results so I’ve also has this concern. I read an article about paracetamol which suggested that we should all be careful about how we use it in combination with other things. As an example, if someone drank a lot of alcohol and woke up with a hangover, the liver is already stressed. Taking paracetamol and coffee on top, adds two more stressors, which can then cause damage even if it’s only 1g of paracetamol.

Having said this, it’s really hard to find out how painkillers interact. I avoid the scenario above, but I do find paracetamol more effective when washed down with a strong cup of coffee. There was an anesthetist on the radio recently who said he takes paracetamol, ibuprofen and coffee in combination for a headache. He didn’t seem worried about his liver, but then again I assume it’s not a very regular thing. For us it’s a bit different.

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I don't drink coffee, the only caffeinated thing I have is tea and that's just a cup, I usually stick to fruit and herbal teas. So washing the paracetamol down with coffee won't work lol!

Most cold capsules have caffeine in so I guess it does help the paracetamol.

Thanks for the info though :)

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I sympathise. The ibuprofen I was given in hospital caused me to develop dyspepsia and severe reflux esophagitis, which has been excruciatingly painful and far more distressing than my endo gynae pain.

Perhaps you could ask for a referral to a pain specialist to find the right level of relief for you.

There are other things to maybe explore like meditation, physio exercises, cbt, tens machines, acupuncture, massage, baths, pain gels (avoiding the liver), sleeping well, destressing and the good old bath or trusty hot water bottles.

I was very sceptical and defensive about the psychology dimension but in the end discovered it had had a far bigger effect on me than I realised.

I am now on a pill called pregabalin which helped my anxiety as well as its intended job of managing my pain messaging brain signals and it made a massive difference and got me out of a originally stress triggered but very real, very physical vicious cycle.

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Glad to know it's not just me that's concerned.

I am looking into other pain management ideas so your list is brilliant! Sleep well will help, unfortunately I'm not a good sleeper due to my circadian (body) clock being slightly out of sync with a day work cycle; I naturally fall asleep at 2am and wake at 10am, this doesn't fit during the week so I end up forcing myself to sleep early and thus losing sleep. Weekends are when I catch up.

Wow, I'm glad you found something that works for you :)

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Glad the ideas are helpful, I'm gradually working through them myself as top up relief for the pain the pregabalin doesn't help with. It's not been a panacea but definitely enabled me to get stable and start to cope again, particularly helping with sleep as I am also naturally a late sleeper like you and insomniac so it was always a problem

Perhaps seeing a sleep specialist could be on the list for you? I was thinking about it until the pregabalin eased things. I've heard melatonin can help but it's quite powerful stuff I believe.

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I've looked into sleep specialists and contacted a few; had some first consultations. They've said they help people with short and long term sleep problems due to stress, medical conditions or emotional problems. They are happy to see and review me over a period of time, but there may not be anything they can do as from what info I've given them it appears it's body clock issue. There's been no scientific evidence to suggest that the circadian clock can actually be changed; you can take short term things to help induce sleep, hormones and precursors, altering the daily pattern of things you do, daylight waking etc, but your clock is just how you work. Most peoples are daylight, some are off by a few hours, some are inverted, it's just how we're wired.

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That's interesting. I've seen a few shows where they helped insomniacs, but I guess the underlying drive is always there. They do say you should always get up at the same time but I've always struggled with that.

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insomniacs have a disruption in their sleep for different reasons, it's usually not a lifelong condition and can be sorted / treated in various ways.

The circadian clock means your body has it's own daily rhythm; if it's off by a few hours from the normal working pattern it can be adjusted but it can take months if not longer and sometimes after treatment it will just go back to what it's always been. It's not that well known amongst the general public, but it is being recognised amongst doctors - circadian rhythm sleep disorders. Basically we're not "normal"! Suggestions are to change your work life balance so that you are properly rested eg get into work later and finish later, if work allows.

Yeah getting up at the same time is difficult when your sleep pattern doesn't fit in with the normal working day! I find if I'm on holiday (off work) I tend to get better sleep as I'll fall asleep naturally at 2am and sleep right through to 9/10ish and can do that for all of my holiday, and I feel so relaxed, energised and rested. If it's a working week I'm completely messed up; go to sleep about 11pm, wake at 2am, sleep, wake at 5am, sleep, then up at 6am to go to work. It's rubbish isn't it :(

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Hi fara, I’m totally paranoid about taking painkillers all the time. I avoid ibuprofen since reading an article on how this can cause issues with your stomach; codeine makes me feel foggy and unable to function; I sometimes need to take tramadol, but I know this is highly addictive; I have naproxen which I have to take omeprazole with, as again it isn’t great for your stomach. Paracetamol seems to be the least stressful on other parts of the body but still has its side effects.

I’m post laparoscopy now and I’ve noticed my diet has a huge effect on the severity of my pain so, if you can, that would be worth looking into. Before the op though I found it extremely difficult to do anything other than just manage the pain and took everything I was prescribed even though most of it didn’t really help, especially when I was pre-menstrual.

I’d suggest take the minimum you can to manage the pain but don’t not take it because you’re worried about other effects (if that makes sense). Managing the pain at this point is probably more important as it can be so debilitating. Hopefully you’ll have a diagnosis soon and something will be done. You can give your body time to recover then, and the liver is particularly good at repairing its self.

Also, I’ve always thought my body clocks natural rhythm was 2am to 10am. I work in a school and in the holidays, this seems to be what I naturally fall into. I manage perfectly well on eight hours sleep when I sleep like that. However, even if I get eight hours sleep but I’m up for work at 7am, I feel shattered all the time. I kind of though it was in my head or I was a freak so it’s nice to know I’m not. Thanks.

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Hey thanks for your reply :)

Yeah I read up about all the side effects of different ones that's why I posted - got worried. Glad it's not just me that doesn't like the idea of painkillers.

Unfortunately I need to take painkillers to manage the pain (luckily just the week around my period) as work wants me to be in, so I can't have too many sick days. But I don't like taking them as they make me feel a bit out of it - kind of groggy, I know the pain is still there just the painkillers block it. I'd rather sort out the source of the pain but in this case there's nothing I can do.

I've had my diagnosis for endo with my lap, and they removed as much as they could, unstuck some organs, but left some on my bowel as they need a bowel surgeon present. So at the moment it's just managing my symptoms until or if I want that surgery.

I've changed my diet loads as I can't really tolerate milk so I have soya / almond / hazelnut / coconut. I don't eat much red meat, and I don't do well with wheat. I just need to eat more varieties of fruit and veg which I find is easier in summer - smoothies and salads :)

Yeah you're not alone with your body clock I get you!

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