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Ask Dr. K: For cirrhosis, try drug-free pain strategies

DEAR DOCTOR K: I have cirrhosis of the liver. I also get tension headaches. What pain reliever can I take for my tension headaches?

DEAR READER: One of the liver’s many jobs is detoxification – ridding the blood of toxins. Cirrhosis, a liver disease, interferes with the liver’s ability to detoxify substances in the blood.

The safest pain medicine for someone with cirrhosis is acetaminophen (Tylenol). However, even this is more risky in people with cirrhosis. That’s because this medicine can be toxic to the liver. There is some evidence that it may be more likely to injure a liver already damaged, such as from cirrhosis.

Another frequently used nonprescription class of painkillers is the non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. Unfortunately, cirrhosis raises the risk of internal bleeding from NSAIDs. Also, cirrhosis makes the kidneys more vulnerable to injury from drugs, particularly NSAIDs. So I think it’s best for people with cirrhosis to avoid NSAIDs.

When possible, use nondrug strategies to relieve pain. Here are some strategies you can try when you experience a tension headache:

• Ice or heat, and rest. Numb the pain with an ice pack, wrapped in a towel and applied to your forehead and temples for 15 minutes at a time. If muscle tension accompanies your head pain, apply heat packs to your neck and the back of your head.

• Tai chi and yoga appear to reduce headache frequency and severity. But they don’t help relieve a headache once it has begun.

• Acupuncture involves inserting fine needles into the skin. This may release endorphins, the body’s natural painkilling chemicals. Acupuncture can be used for relieving head pain as it occurs and for reducing headache frequency.

• Biofeedback. Head pain is often triggered by muscle tension. During biofeedback sessions you’ll learn to recognize when you’re tensing up the muscles in the back, neck, shoulders or head – and to relax them before they cause pain.