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Which is the better pain reliever for Crohn's Disease? Advil, Tylenol or Aspirin?


Sports Crohnie
Advil seems to do nasty things to your stomach.
Tylenol can damage your liver (and if you're on 6mp, that ain't good).
Aspirin...I don't know.

I know that my GI mentioned I could use Tylenol occasionally... ADVIL and Aspirin I was recommended to not use...specifically avoiding the Advil tho...
Ibuprofen you're supposed to avoid. I've been told Tylenol is the way to go. If you're a bleeder than you're supposed to avoid aspirin since it's a blood thinner and can make things worse.


ele mental leprechaun
Spot on Drew..

ANY NSAID such as Ibuprofen (Advil), Diclofenac (not sure what you guys call it as a brand name - here it is Voltarol) should not be taken.

Non Steroidal Anti-Inflammatory Drugs - NSAID's as mentioned above should be avoided by crohns folks as it can increase ulceration and other problems in the gut such as bleeding.

Tylenol (acetaminophen or paracetamol as it is known here in Europe) is the most recommended/commonly used painkiller. Yes it CAN potentially impact on the liver when taken long term or if more are taken in 24hrs than recommended.

Aspirin does have a relative in some of the drugs we take which I will highlight later but as a rule the drug aspirin should be avoided by anyone who does not have agreement to take it by their health care provider. It has the potential to contribute to bleeding as Drew rightly says as it impacts on what is called the clotting cascade and means it takes longer for you to clot. This is why heart attack patients are given aspirin in an acute attack and are on it regularly afterwards. They should also be prescribed a stomach protectant like Omeprazole or Lansoprazole as aspirin can also contribute to ulceration.

I had a patient die because he was on aspirin for years and his GP didnt prescribe the stomach protectant. It wasnt until MY GI scoped his stomach it was found he had hundreds of ulcers all through his upper small bowel and stomach. So he survived his coronary heart bypass grafts operation and died from stomach ulcers!

Fenway, you will find ALL painkillers have side effects just as all other meds do unfortunately. The trick is to weigh up the benefits versus the risks as always. Tylenol is the least likely to cause problems overall.

BUT ANY painkiller should only be taken intermittently IF possible rather than continuously. This is because the body adapts and over time MAY need stronger painkillers to cope with the same level of pain. This is known as climbing the analgesic ladder.

At the bottom of the ladder is Tylenol and at the top are drugs like Morphine etc.
In between you have the NSAID's and others like Tramadol (of which a side effect is nausea and constipation which are both common to crohns folks anyway so it can be hard then to work out what is crohns and what is side effect).

Other drugs can be used for different types of pain. Amytriptyline (sp?) (is used to help folk sleep and also to cope with depression) and Gabapentin (is an anti epileptic drug) are both used for nerve pain but generally prescribed for other conditions originally. They were discovered as part of THEIR side effects to have a beneficial effect on this type of pain in small doses. Again though they can have an adverse effect in other ways so its about balance.

My Asthma consultant and my Rheumatology consultant recently swapped letters as the Asthma cons wanted to bring me into hospital and see if I had a problem reaction wise with these meds and aspirin based meds as my asthma deteriorated to the point of hospitalisation over a period of months when I started Mesalazine for my crohns and then it improved once I stopped it so they think I have an allergy/intolerance (which incidentally our 5ASA drugs like mesalazine, sulfasalasine work in a SIMILAR but not the same way to. They dont fully understand what they do but do know they decrease inflammation).

Rheums refused to admit me on the grounds of my crohns and told my asthma cons they would not be commencing me on ANY NSAID because of the impact these meds could have on my gut.

Ironic it was all about my crohns and yet my GI team never even had to open their mouths! LOL

Basically what it comes down to is taking the drug that has the best impact FOR YOU with the best benefits and least side effects. Tylenol usually fits that list for many and if anything stronger is needed either intermittently or regularly then it needs regular review to ensure safe management. Also if anyone is taking Tylenol constantly then it needs reviewed as there is a reason for the pain!

As I said earlier its about balance and need against the potential risks.

Certainly can be a minefield cant it? Hope I have helped to clarify the different meds and not muddy the water and cause more confusion.
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The interesting part about Aspirin and the 5ASA drugs that Crohnies take is that Aspirin is actually an ASA itself .. ASA = acetylsalicylic acid .. yeah I had a hard enough time learning how to say Azathioprine .. not even gonna try that one =) I'm not sure of the differences though.


Sports Crohnie
Thanks, Jan, Drew and Jamie.

I'll throw my Advil pills out the window and buy some Tylenol. Having bad headaches and now wondering if it's a sinus infection even though I have no symptoms other than headache.


ele mental leprechaun

Will leave you pair to do the tongue twister words

Am enjoying watching you LOL

Good point Drew.
Aspirin is okay in small doses and/or short periods. A study was done last year with putting crohnies on various NSAIDs for a 2 week period and while the dual-cox inhibitors (ibuprofen, naproxen, etc,) resulted in a large number of flare-ups the cox-2 inhibitor (aspirin, etc) group had no increase in flares (slightly less than the control group, actually, but well within the margin of error). The reason for the study was to okay aspirin for use in crohn's patients with heart problems as well.
drew_wymore said:
The interesting part about Aspirin and the 5ASA drugs that Crohnies take is that Aspirin is actually an ASA itself .. ASA = acetylsalicylic acid .. yeah I had a hard enough time learning how to say Azathioprine .. not even gonna try that one =) I'm not sure of the differences though.

5ASA's differ from NSAIDs (google "the difference between 5ASA and NSAIDs).

NSAID's actually contribute/cause bleeding in the intestines for those with any form of IBD, which is why they should all be avoided (aspirin, advil, aleve, ect) Tylenol is the safest way to go.



Sports Crohnie
Just saw primary doc. Tylenol is the way to go. Definite no to Advil.

Still have headaches. No idea why...going in for further tests. Hoping it isn't serious.
good luck with the testing
i hope it turns out just to be the stupid pred, but its good that youre getting it checked out.

and yup yup, tylenol is my drug of choice too. i wont reiterate anything, its all been covered by the forum professionals :) lol