Q I suffer from back pain intermittently and over the years, I have spent a fortune on physio, acupuncture, massage – you name it. I no longer spend any money on it and just manage with painkillers when it arises, which is about once every three months or so. I use over-the-counter, codeine-based products. I am not worried about addiction as I understand and follow the rules, but I am worried about the effect on my liver. Typically, I would take the painkillers at the top dose for three days straight during bouts. Is this ultimately going to harm my health?
A My advice on codeine-based products is use with caution, and it seems you do. Codeine does not have any known liver toxicity but is usually taken in combination with paracetamol. More than four grammes a day of paracetamol may adversely affect your liver function. However, you only take the full dose for approximately three days every three months and this should not have any long-term adverse effects. Common codeine-related side-effects include constipation, nausea and drowsiness and, as you mentioned, the potential for developing dependence.
Sensible use of painkillers containing codeine in combination with paracetamol for a few days, a couple of times per year, is safe, when you have normal liver function. Other factors that contribute to normal liver function include safe weekly alcohol intake, normal LDL (bad) cholesterol levels, normal level of iron stores (not iron overload) and normal Body Mass Index (BMI).
I am concerned about your lack of routine care for your recurrent episodes of low back pain. In cases of more persistent low back pain that fails to improve over time, the need to obtain a spinal MRI or CT scan should be discussed with your GP. Specific causes of low back pain include spinal fracture (due to osteoporosis or trauma), infection, malignancy (more common in the older person), ankylosing spondylosis and other inflammatory disorders.
Complications of low back pain include radicular pain due to nerve root compression resulting in sciatica, or the cauda equina syndrome (a rare surgical emergency) when there is weakness/loss of sensation in one or both legs and the control of urinary and/or faecal continence is generally diminished or lost altogether.
Sciatica occurs when the contents of the disc (located in between each spinal vertebra or bone) bulge out and press on one of the nerves as it exits the spinal canal, causing pain to radiate down the leg.
For someone (like yourself) who suffers recurrent episodes of low back pain, it is imperative to perform weekly exercises to prevent these attacks. By being diligent with your back care, you can prevent these recurrent episodes of low back pain and the use of painkillers. You should seek professional help as this will prevent further injury and ensure proper technique. I suggest you return to physiotherapy for assessment of your quadriceps, hamstrings, gluteal (buttock), abdominal and paraspinal muscle strength and your spinal flexibility. Unfortunately, over 30 years of age, there is a natural decline in muscle mass and therefore strength, with the loss of up to one pound of muscle per year (often converting to fat) unless you fight back. Of course, it is a nuisance to have to perform strength and conditioning work every week, but you will reap the rewards if you start to fight back now.
⬤ Dr Jennifer Grant is a GP with Beacon HealthCheck
Health & Living