In The Pursuit of Pain Relief; Lesson from Drug Overuse

It was 2016, I was a first year medical student and I had severe pains in my armpit. This was a day after shaving my armpit hairs and the pain was severe. I could not endure it anymore and I called my mum who linked me up with a doctor and I spoke with him on the phone.

He prescribed diclofenac and I bought it and began taking it. The pain subsided and finally stopped after several days of taking the drug.
A few days later, I was at home feeling sick and weak. Before long, I collapsed and was rushed to the hospital.

Guess what? I had suffered intestinal perforation and had GI bleeding which led to me loosing a lot of blood and becoming anaemic.

What Happened?

I learnt that diclofenac belonged to a group of drugs called Non-steroidal Anti Inflammatory Drugs (NSAIDs) and these dugs typically had the side effect of causing gastric and intestinal mucosal damage.

I didn't know about this and I wondered why the doctor didn't inform me about this side effect. To be fair to the doctor, I abused the drug by taking it for 11 days straight instead of the usual 3 days because of the persistence of the pain, I didn't know I was slowly killing myself.

Did you research your condition further? What did you find out?

Well, I didn't research this on my own but I asked all my caregivers questions and interacted with them as a junior colleague. They were eager to teach and discuss with me and they began to use medical jargons in our discussion when they learnt I was a student doctor. They treated me and taught me at the same time.
I learnt so much about NSAIDs that when we started pharmacology in the fourth year and we got to the topic cyclooxygenase inhibitors, I grasped it with ease and would later teach my friends who did not understand it as quickly as I did.

My hospitalization taught me with personal experience a lot about NSAIDs, Gastric and duodenal ulcers and the importance of patient education during management and prescriptions.

These have formed part of the pillar upon which I base my consultations now as a doctor. I always ensure to inform patients the dangers of abusing a drug while patiently explaining the dosage and duration it should be taken.

It is common to see doctors hurriedly attend to patients, either because of the long queue outside or the tiredness from long hours of work but this could be catastrophic because if your instructions are misunderstood and executed wrongly, it could be life threatening.
And from experience, I know this.

How can people prevent or manage a similar health issue?

When in pains and in need of taking these drugs, it is important to remember the side effect and prevent it by ;

1. Eating enough food before ingesting them and
2. Not taking them longer than 3 days regardless of the quantity of food you eat or the intensity of the pain.

It is also noteworthy that there are now NSAIDs that function without this side effect because their actions are specific and targeted towards pain relief and not mucosal damage. Drugs like Arthrotec, celecoxib and rofecoxib are pain relief drugs that preserve the mucosa and as such can be used in place of the traditional NSAIDs like diclofenac, ibuprofen, etc.

It has also helped me to always remember to rule out ulcer in a patient before prescribing pain relief and to prescribe according to the clinical signs.

What advice would you give to someone who's going through a similar experience?

Visit the hospital and adhere to the management protocol instituted by the health practitioners.

It's a relatively simple case but can be life threatening if not properly managed.

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All images are mine

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