Conway McLean, DPM, Journal columnist

Not very long ago, an arthritic knee or aching head were to be suffered through, endured, with no options for pain relief. With the advent of modern pharmacology and the rise of the pharmaceutical industry, it would seem we now have innumerable options for reducing pain. Walk through the aisles of any pharmacy and find shelf after shelf with a multitude of products. But closer examination will reveal something interesting: only a few choices exist for over-the-counter pharmaceutical agents for pain.

Naturally, our culture promotes choice, so there are numerous products for mild to moderate discomfort. Although they may all have different names, the important ingredients consist of just 3 or 4 analgesic substances. As most would guess, the first of the current generation of off-the-shelf pain relievers is that famous household product, the subject of many commercials from yesteryear, aspirin. The word itself, once a proper word, a brand name, like Kleenex or Tylenol, capitalized. It’s now part of the lexicon, everyday language, familiar.

This is a pharmaceutical agent with a rich history of development and deployment. It was at the turn of the 19th century that the analgesic and antipyretic (fever reducer) was introduced. Felix Hoffman is the chemist credited with developing the specific substance acetysalicyclic acid, often referred to as ASA. Aspirin is one the best researched drugs in the world.

It is classified as a member of the non-steroidal anti-inflammatory group, the NSAID’s, like the popular ibuprofen (Advil, Motrin) or naproxen (Alleve, Naprosyn). The word itself is a combination of some of the components of the chemical which is aspirin. It has been used for a variety of its effects, from the prevention of clotting to the aforementioned reduction of fever. These, in addition to the famous pain relief.

The substance which makes aspirin effective is primarily salicylic acid. It’s been used medicinally in various forms since antiquity. One common method was via the use of willow, a leaf which contains the natural compound that aspirin is made from. The use of willow leaf medicinally appears in clay tablets from ancient Egypt. An herbal tea was utilized by Hippocrates to ease the pain of childbirth around 400 BC. This chemical, salicylic acid, the basis of the drug aspirin, was first synthesized in 1853 by a French chemist.

Perhaps most consequential in recent years is aspirin’s ability to alter the clotting cascade, the natural process leading to the formation of a blood clot, like the scab that forms when a finger is cut. Because of this action, some years ago, the recommendation was made for people over 50 who were at higher risk of a stroke or heart attack to take a daily low-dose aspirin. For years, millions of Americans have followed these guidelines on a regular, long term basis… sometimes to their detriment.

How does aspirin work as a blood “thinner” (although it in no way changes the thickness of blood). It slows clotting by making the blood cells responsible for formation of a clot, the platelet, less sticky. Reducing the likelihood a clot will form in one of the vessels leading to the heart lessens the risk of an attack. But this means bleeding may not stop in a timely fashion where and when it is needed. A stomach bleed, in which there is (hidden) blood loss into the stomach cavity, too often results.

Like pretty much every drug, aspirin has a variety of potential side effects. Some of the harmful consequences of the drug include irritation of the stomach or intestines, nausea, vomiting, or stomach cramps. There are others, more severe, less common. But the benefits of reduced clotting are also an integral part of its dangers.

After numerous studies, the tide officially turned during the last decade. Even that august body, the conservative American College of Cardiology, changed its position on the topic, issuing a statement in 2019 that people over 70 should not routinely take a daily aspirin. The explanation is the risk of gastrointestinal bleeding is too high in relation to its benefits.

This is big news. Many individuals have continued the practice, a daily aspirin, thinking they were doing themselves good. On the contrary, the long term use of aspirin can have significant consequences. Don’t assume that some medical practice, described as beneficial by a neighbor or relative, will be good for you. New evidence is revealed, more definitive studies performed every day. Medical advances are made, new recommendations are made. But be careful where you get your medical advice. Dr. Google doesn’t know your health history… and doesn’t care.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula. Dr. McLean’s practice, Superior Foot and Ankle Centers, has offices in Marquette and Escanaba, and now the Keweenaw following the recent addition of an office in L’Anse. McLean has lectured internationally, and written dozens of articles on wound care, surgery, and diabetic foot medicine. He is board certified in surgery, wound care, and lower extremity biomechanics.