The Hidden Cost of a Painkiller: When Relief Turns Risky

Dr. Shane Halpe - Senior Registrar in Family Medicine

A few weeks ago, during a conversation with a fellow GP colleague, I was reminded how easily even doctors can fall into the trap of self-medication. The story he shared stayed with me — not just because it was about a respected Family Physician, but because it revealed how silently a simple pill can cause harm.

Let’s call him Dr. Shankar. He’s a busy Family Physician based in Negombo — well-known, kind, and deeply committed to his patients. His mother, now in her nineties, still lives in her ancestral home in Jaffna. Every few weeks, he travels overnight to see her, often taking the express luxury bus. It’s a long and tiring journey — hundreds of kilometres up and down the island.

 After months of this routine, he began to notice a dull ache in his neck. Sitting upright for hours at a stretch, often dozing off on a bus seat, left his neck muscles stiff and sore. Like many of us, he didn’t think much of it. He simply took a painkiller — diclofenac sodium 50 mg — to get through the day.

The tablet worked. The pain eased. So he took another the next day. And the next. Soon, swallowing a painkiller before work became second nature. He didn’t tell anyone — after all, he was a doctor and knew what he was doing. Between clinic sessions, home visits, and lectures, there was never time for a full check-up.

A Shocking Discovery

Dr. Shankar already had hypertension and diabetes, controlled with enalapril, hydrochlorothiazide, and empagliflozin. These medicines kept his blood pressure and sugar in check — but they also made his kidneys more vulnerable to harm.

 One day, on the insistence of a friend, he reluctantly agreed to do a routine blood test. The results arrived — and they were alarming. His serum creatinine (a marker of kidney function) was high. His urine albumin-to-creatinine ratio — which shows protein leakage — was around 700. His sugar and cholesterol were fine. His blood pressure was perfect. Yet his kidneys were struggling.

The likely culprit? The painkillers.

Long-term use of NSAIDs (non-steroidal anti-inflammatory drugs) like diclofenac, ibuprofen, or mefenamic acid can reduce blood flow to the kidneys. When combined with medicines such as ACE inhibitors (like enalapril), diuretics (like hydrochlorothiazide), and SGLT2 inhibitors (like empagliflozin), the risk multiplies.

Doctors call it the “triple whammy” or “quadruple whammy”— a dangerous mix that can quietly push the kidneys toward failure.

Fortunately, Dr. Shankar’s condition was caught early. He stopped the painkillers immediately, sought help from a physiotherapist and orthopaedic specialist, and began using a soft collar while travelling. With care and follow-up, his kidney function stabilized. But the experience left a lasting lesson — one that deserves to be shared.

The Lesson Behind the Story

Painkillers like diclofenac, ibuprofen, aceclofenac, naproxen, celecoxib, and etoricoxib are easily available and often used without much thought. Taken occasionally, they’re safe for most people. Taken regularly, especially in those with high blood pressure, diabetes, or heart disease, they can quietly damage the kidneys — a condition known as analgesic nephropathy.

This risk is higher in older adults, those who are dehydrated, or anyone already taking medicines that affect kidney function.

Safer Ways to Manage Chronic Pain

If you find yourself needing painkillers often, it’s time to look deeper. Pain is the body’s way of saying something isn’t right. Masking it with tablets may bring relief but can hide the real cause. 

Here are a few safer approaches:

●     Gentle physiotherapy and stretching to ease muscle stiffness.

●     Stay hydrated, especially when taking any medication.

●     Paracetamol (acetaminophen) is generally safer for mild to moderate pain when used correctly.

●       Ergonomic posture and supportive seating for long travel or desk work.

●       Consult your doctor before taking painkillers regularly — even if you are one!

A Final Word

Dr. Shankar’s story reminds us that health literacy isn’t just about knowing — it’s about applying that knowledge to ourselves. In medicine, we often help others heal, but forget to listen to our own bodies. So the next time you reach for a painkiller, pause for a moment. Ask yourself: Do I really need this today?

Because relief should never come at the cost of tomorrow’s health.