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Okay, so ibuprofen impacts testicular function, acetaminophen/paracetamol causes muting of emotional response (along with the liver toxicity), many other painkillers are related to ibuprofen, and opiates are Right Out.

Is aspirin at least reasonably safe as long as the blood thinning isn't a problem?

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I can’t take Ibuprofen (or any typical NSAIDS including aspirin) because of a medical condition, which has sucked over the last decade because acetaminophen really doesn’t help me at all when I’m excruciatingly sore for whatever reason.

In Oregon and Washington, where I’ve lived for pretty much my entire life, legal marijuana has been amazingly helpful, at least since I finally got around to trying it.

The various products out that are high in CBD and low in psychoactive ingredients have been really good at even my worst muscle aches and really painful, but not super serious, injuries like sprained ankles and such.

My surgeon after hip surgery even blessed the notion of using the opiates I was prescribed for as short as possible and then using high CBD edibles to cover the gap between excruciating post-op pain subsiding but still being in a lot of pain. In fact, he didn’t just bless the idea, he practically endorsed it as a “still emerging but very likely positive course of treatment” in his words.

I don’t use CBD like someone might (even if maybe they shouldn’t) pop ibuprofen, but it’s great to have an option between acetomenaphin and opiates.

>he didn’t just bless the idea, he practically endorsed it as a “still emerging but very likely positive course of treatment” in his words.

I love it! It's really sad and fucked up watching the federal government flail around trying to say otherwise. Meanwhile, they are getting all of their ducks in a row to ensure they can profit off of full on recreational legalization when that time comes. Between this issue and the healthcare issues it's terribly obvious the citizen's health and best interest is not first or maybe even second in order of importance to these people.

I use CBD infrequently for pain.

Chronic high CBD usage will result in withdrawal upon cessation.

The 5HT1A agonism aspect of CBD makes for a particularly bleak and anxiety ridden withdrawal.

Not sure if it's CBD or THC, but coming off pot makes you realise how madly your REM sleep was disturbed (or basically non existent).

Part of smoking pot I enjoy initially is amazingly deep sleep, but that can't be good in the long term.

Actually, you don't get REM when you smoke. That's why you don't dream and it's why it comes back full-swing when you stop. I occasionally smoke and drink (alcohol also disturbs REM quite a bit), but I try and do it early in the day so I can get quality sleep.

I think kratom is helping me. I experience no psychotropic side effects, which is great. At some point, I'll stop kratom for a few months, see how my pain mgmt handles it.

YMMV.

If you don't mind answering (as vaguely as makes sense), what kind of pain? Where is it focused (exclusively the hip/s?), what does it derive from?

Depending on the nature of it, you might look at this:

https://www.amazon.com/Genacol-Hydrolyzed-Supplement-Extra-F...

I'll suggest you do your own research on it of course. I've known a few people, myself included, that have seen extraordinary results from taking it for various pain related to anything to do with joints (very split results on working or not, seems to do amazingly for some, and nothing for others). I didn't expect it to do anything, instead it saves me from taking pain killers every day (took my pain from a persistent 5 out of 10 to a 1 or 2 on most days, such that I never need pain killers; I take two each night).

I had to have hip arthroscopy because I had an impingement, leading to quite a bit of cartilage damage/labral tearing in the joint. They even had to reshape the end of the femur to remove the impingement. It's quite a recovery period of crutches, cane, etc. and the pain from the surgery was _supposed_ to be quite immense. Honestly, my hip hurt so bad for so long that even a day post-op it was less painful than it was when I went in. I only needed the opiates for a couple of days and used CBD once or twice a day for about a week- after that the pain was just a dull soreness.

Luckily, there was very little arthritis in the joint and three years post-op it's felt just fine and I've had no set backs whatsoever. Luckily I've not had to look into any type of long term pain management for anything.

Can't use aspirin in children and teenagers because of the risk of Reye's Syndrome.

https://www.mayoclinic.org/diseases-conditions/reyes-syndrom...

The link to aspirin is dubious at best, which is why it’s always phrased as “linked to,” rather than any language endorsing causality.

We’ve simply gone with a policy of “better safe than sorry,” because of the risks/benefits involved here.

1000 cases in the US, which means you're about 30x more likely to die in a car accident in any given year. Also, the syndrome isn't immediately lethal.

When people worry about infinitesimally small risks, it always makes me chuckle.

That's 1000 cases when we restrict children from taking aspirin, it could be a lot more once we let them

No, it was under 1000 cases per year in the US before the association with aspirin was known. Over the next 14 years it dropped to about 2 per year.

I had Reye syndrome without having taken aspirin.

Obviously one person commenting doesn't disprove your point at all. But it's an odd feeling to be that person.

No, Reyes is very rare even when parents gave sick kids chewable baby aspirin almost like candy.

1000 cases in the US because there are no child friendly pain medications (sweet syrup and oral syringe) but by all means risk your child’s liver to prove us all wrong

Quite normal in the UK to use calpol (paracetomol) and nurofen (ibuprufen) in a 5ml syringe (doses at 2.5, 5, 7.5 and 10 as the child gets older).

What do you do in the US?

Paracetamol is acetaminophen (Tylenol) and both are commonly given to children. Aspirin typically only if a doctor says it's ok.

In Europe, there's Aspirin-C and Upsarin, basically, pure aspirin with vitamin C, which eliminates the stomach lining issues [0]! I have no idea why this is not offered in America. Maybe, because there's no way to make money from patents and stuff!

[0]: https://www.huffingtonpost.com/leo-galland-md/aspirin-and-vi...

I wrote a lengthy post about how ridiculous this was, until I got to the citations section, which I then dutifully hunted down.

I must in all fairness upgrade this from “HuffPost-endorsed vitamin cult quackery” to “plausible, if supported by weak studies.”

> Maybe, because there's no way to make money from patents and stuff

That's definitely not the reason. The over the counter pain killer / pain management sections in CVS, Walgreens and Walmart are half filled with generic options.

No, it could be the reason. The patent/money issue is related to the initial FDA approval, which is very expensive (clinical trials).

If no one foots the bill for the testing, it won't spawn a FDA approved thing, right? And if it's not patentable, then it's not worth the effort to go through those hoops, because you won't be able to recoup the costs of doing the FDA approval steps because others could also bring generic versions to market right away, without a cool-down period, and at the same price.

If it is patentable, then it's worth it to make the drug and get it approved. You'll have 20 years to recoup the costs before generics can appear.

Asprin seems to increase intestinal permeability.

https://www.ncbi.nlm.nih.gov/pubmed/22377941

https://www.ncbi.nlm.nih.gov/pubmed/25641731

For Dengue fever, aspirin can be fatal:

"infecting organism in dengue affects the platelets which are responsible for clotting (stopping bleeding) increasing the tendency of the person to bleed. Aspirin and Ibuprofen also have similar action. Both of them together could cause the person to bleed excessively pushing the patient into what is called the ‘Dengue Shock syndrome’. And once in this stage, medical treatment is needed in an emergency basis and hospitalization becomes necessary"

http://www.thehealthsite.com/diseases-conditions/dengue-feve...

Infrequent, occasional use of opiates, for two or three days shouldn't be a problem. You do have to make a bit of an effort to get addicted to opiates, insofar as taking a pill a day for a couple of weeks constitutes effort.

I had seemed to think that 10 days was the threshold but it turns out to be half that - http://www.newsweek.com/cdc-opiate-addiction-572498

Great reference, thanks!

From the link you provided:

According to the report, the transition from an initial prescription to chronic use begins very early on. Even a one-day opioid prescription carried a 6 percent risk of use at one year later and a 2.9 percent risk of use at three years later. The sharpest increases in the likelihood of long-term use came at five days after the initial prescription, with another spike seen at one month.

Whoa! That's frightening.

some people can't handle the effect on the stomach. but if you can handle it, it's a good choice. Or marijuana

> marijuana

Unless that makes you anxious.

In that case, use ketamine?

In all seriousness though, there is research being done and evidence to suggest that ketamine can be used for pain management. Most of it seems to be about using it synergistically with opioids, to reduce the amount of opioids required.

sadly ketamine has severe side effects https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4678404/

CBD?

Cannabidiol = Marijuana - THC

Not at all. Maybe Marijuana - THC - THCV - CBG - CBC - CBGV - CBCV - CBDV?

Unless you're not in a marijuana friendly jurisdiction

Marijuana kills your short term memory.

the low/no-thc high-cbd strains generally don’t do this.

It does screw up your sleep massively (basically REM sleep is gone)

it can, yes. i still dream at a microdose level.

I tend to use naproxen but something tells me that would kill me as well

I think that all NSAIDs (like naproxen and ibuprofen) chew holes through your stomach lining, and a whole class of them were yanked from the market for causing heart attacks[1].

(But, yeah, naproxen seems to be one of the safest ones...)

[1] https://en.wikipedia.org/wiki/COX-2_inhibitor

> (But, yeah, naproxen seems to be one of the safest ones...)

Kind of.

But it starts to feel a little uneasy taking it all the time once you realize that naproxen's regulatory approval came from https://en.wikipedia.org/wiki/Industrial_Bio-Test_Laboratori... data.

All stomach effects are due to decreased prostaglandin levels. All NSAIDs function through inhibition of prostaglandin synthesis.

The exception is Tylenol/acetaminophen, as it doesn’t have an anti-inflammatory effect / doesn’t seem to act primarily on COX1/2. It’s currently popular to bandy about the theory that it targets spinal COX3.

https://en.wikipedia.org/wiki/Nonsteroidal_anti-inflammatory...: "NSAIDs cause a dual assault on the GI tract: the acidic molecules directly irritate the gastric mucosa, and inhibition of COX-1 and COX-2 reduces the levels of protective prostaglandins" (emphasis added)

Aspirin and many other nonsteroidal anti-inflammatory drugs (NSAIDs), (eg, ibuprofen, naproxen, indomethacin, and ketorolac) are carboxylic acids. Their pKa values range from 3.50 (aspirin) to 4.85 (ibuprofen). As such, they are not ionized at the acidic pH found in the gastric lumen and thus can be absorbed across the gastric mucosa. Once these drugs move from the acidic environment of the gastric lumen into the pH–neutral mucosa, the drugs ionize and are trapped temporarily in epithelial cells where it may damage these cells. How important is this effect? Calcium carbsalasate does not have this epithelium damaging topical effect, but causes the same ulcerative outcome[1].

This "topical" epithelial injury by many NSAIDs does not appear to be of prime importance in the pathogenesis of clinically important endpoints (symptomatic ulcers). The pathogenesis of symptomatic peptic ulcer disease caused by repeated exposure to NSAIDs is mainly a consequence of systemic (post-absorptive) inhibition of gastrointestinal mucosal cyclo-oxygenase (COX) activity. Even intravenous or intramuscular administration of aspirin or NSAIDs can cause gastric or duodenal ulcers in animals and humans [2].

PMIDs: 1 - 18242146 (“The incidence rate of peptic ulcer disease is similar in patients using low-dose effervescent calcium carbasalate compared with regular low-dose acetylsalicylic acid. This implicates that peptic ulcers seem to be related to systemic rather than to local effects of low-dose acetylsalicylic acid.”) 2 - 631484 (“These studies show that when the stomach is acidified by giving histamine intravenously or HCl intragastrically, intravenous aspirin produces large deep gastric ulcers.”)

The above is a partial paraphrase from UpToDate.

That study also raised concerns about older NSAIDs (including aspirin, acetaminophen and ibuprofen):

http://circ.ahajournals.org/content/115/12/1634

Funny thing, naproxen is much kinder to your stomach than ibuprofen, but it's not generally used (and may be prescription-only?), in Australia at least. It does, however, carry a minutely increased risk of heart attack / stroke. I guess they'd rather give 1000 people ulcers than 1 more person die in a lawsuit-attracting fashion.

Naproxen is OTC in the US, as Aleve, but you need a prescription for higher doses, like with ibuprofen.

That sort of logic has never made sense to me. It's as if the regulators think people would never take more than one at a time.

The regulators think, quite correctly, that people will generally take the dose on the bottle. If you only allow sales of Ibuprofen in 200mg pills and the bottle says “take two”, that’s what the vast majority of the public will do. If you allow sales of “ultra strength” 2000mg pills, a decent chunk of the population will take 2-4 grams because “ultra” must be better.

You can’t buy more than 2 packs of 200-250mg ibo in the UK at the time, and only one pack of anything higher, doses above 500mg require a prescription.

Prescription Ibo can be 2000-5000mg per pill so yes it does reduce the risk.

That's... different. Here in the US I can walk into into any pharmacy or supermarket and buy a bottle of 500 or even 1000 200mg does for <$20.

That's pretty insane, 10 or 12 ibo pills here cost like $5-6 and the UK is considered to have relatively cheap OTCs.

Hrrm?

This site seems legit, and offers 84 400mg pills for #2.99

Naproxen (and Ibuprofen) can both cause kidney damage, particularly when you are physically active and/or not hydrating well (where hydrating well means getting enough sodium and glucose in addition to water). After experiencing kidney pain after taking naproxen on a hike and learning about this possible side-effect I am now very careful about naproxen use.

http://www.gssiweb.org/en/sports-science-exchange/article/ss...

http://www.mdpi.com/1424-8247/3/4/1279/pdf

Good Scotch?

As long as dengue fever (that has exactly the same initial symptoms as a flu) is not a possibility...

Well you can still use CBD though.

In case you were wondering: Cannabidiol (INN;[3] abbreviated as: CBD) is one of at least 113 active cannabinoids identified in cannabis.[4][5] It is a major phytocannabinoid, accounting for up to 40% of the plant's extract.

https://en.wikipedia.org/wiki/Cannabidiol

It’s worth noting that a legal version, extracted from Hemp (a form of Cannabis that has no psychoactive properties), is available via mail order anywhere in the U.S.

I've wondered about the efficacy of the hemp versions. A friend of mine was using CBD oil to alleviate his daughter's seizures, and had told me that the hemp based ones were ineffective, and that THC in a small dose had a complementary effect.

I'm not sure if that applies to everything CBD is good for, but does anyone know if it works mostly the same for body aches and the like?

I’ve tried both (for migraines) and didn’t notice much of a difference.

I looked into the hemp based extract a while back and the conclusion I drew was that it was up for debate whether or not it was legal. Proponents cited a bunch of laws regarding industrial hemp while the DEA seemed to have another position entirely. Was this finally settled or is it still a bit gray?

Since vitamins and supplements are totally unregulated it could be that it doesn't actually contain any of the active ingredient it claims it does, thereby avoiding any legal issue.

i've heard of a cbd extract from hops, but i'm not sure whether it's true.

Hemp is not "a form of" cannabis. It IS cannabis.

Sorry...I should have said “variety” instead of “form.”

aspirin might be bad for your teeth: http://jada.ada.org/article/S0002-8177(14)61356-8/fulltext

Turmeric is my pain killer of choice.

Turmeric is not a pain killer.

I haven't heard that, either. I have heard that it has anti-inflammatory properties, which could indirectly reduce pain that arises from inflammation, such as arthritis. Here's one article describing it.

http://content.time.com/time/health/article/0,8599,1910028,0...

Your comment is quite brief (as is the one you're responding to, for that matter). Is there something in particular you have in mind?

Try 1 TB/day and you'll definitely get an analgesic effect.

I hope that dipyrone be safe.

May cause agranulocytosis, according to wiki. https://en.wikipedia.org/wiki/Metamizole

* and stomach ulcers

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