Hepatitis C: pain management
Managing pain or discomfort of the liver
Some of the symptoms associated with hepatitis C can cause pain. People with hepatitis C may experience episodes of abdominal pain. Pain or soreness on the right side just below the ribs could be from the liver.
Before attempting to treat pain or discomfort of the liver it is important to discuss symptoms and pain management with your doctor. For some people reducing alcohol consumption to below levels recommended for the general community or abstaining from alcohol altogether, may bring relief. Using a heat pack over the liver, particularly at night, may also relieve liver pain or discomfort.
Pain relief medication, both over-the-counter and on prescription, is generally considered acceptable for temporarily treating liver pain—but there are exceptions. The use of pain medication in people with hepatitis C should first be discussed with your doctor.
Managing muscle and joint pain
People with hepatitis C may experience muscle and joint pain. Common sites of joint pain are the hips, knees, fingers, and spine, although any joint can be a source of pain. Pain associated with hepatitis C can move around and come and go. Aches and pains in the muscles are usually experienced as a generalised feeling. However, some people report having pain in only one area of the body.
It is generally considered acceptable to take anti-inflammatory medication for muscle and joint pain (following the instructions on the packet). However, you should first consult your doctor about the use of anti-inflammatory drugs.
Some people find mild physical activity can help manage muscle and joint pain. Mild physical activity increases blood flow to joints and muscles and can reduce stiffness. Heat packs on the sore area, warm baths and massage may also provide temporary relief.
Some people find benefit in complementary and alternative therapies, such as herbal products or massage. It is best to be advised by a qualified complementary/alternative professional about any therapies or products that could be useful. If you pursue complementary and alternative therapies it is important that you tell your liver specialist and GP of any therapies that you have recently used, are using, or plan to use.
Can I take pain killers if I have hepatitis C?
One common mechanism for managing pain in our society is over-the-counter pain killers (or analgesics). A common question that many people with hepatitis C ask is whether over-the-counter pain killers (or analgesics) are harmful to the liver (as the normal activity and effects of analgesics on the body may be altered by liver damage). Generally speaking, when taken according to directions, the answer is no—but there are exceptions. In all situations, for people with hepatitis C, the use of analgesics should first be discussed with your doctor. Your doctor is the best person to advise you on the safest use of analgesics.
It is important to follow the manufacturer’s advice when using over-the-counter pain medication and never exceed the recommended dosage.
Paracetamol
Paracetamol is used to relieve mild to moderate pain. It also lowers body temperature in patients with fever. Paracetamol is marketed as Panadol or Panamax.
Paracetamol is generally regarded as safe when taken according to the recommended dose. However, there are exceptions and you should discuss the use of paracetamol with your doctor prior to use.
When there is liver damage, one of the key enzymes involved in the breakdown of paracetamol may be low. This means that the paracetamol level in the body is higher and toxic effects may occur. However, in many people with hepatitis C, liver metabolism (the breakdown of substances in the liver) is satisfactory and the body’s processing of paracetamol is not affected.
When taken in high doses, paracetamol can cause liver injury, even to a healthy liver.
Aspirin
Aspirin is used to relieve mild to moderate pain as well as treating fever. It also has an anti-inflammatory effect in that it reduces swelling and inflammation.
Aspirin also has an effect on platelets in the blood, it temporarily limits the clotting process and bleeding may be prolonged. In chronic liver disease, where the body’s production of clotting factors is naturally decreased, aspirin has been shown to increase the risk of bleeding.
Although there is no actual drug interaction between aspirin and the drugs used in interferon therapy, both can disrupt blood clotting processes and this should be considered if used together.
When taken in high doses (more than 2000 mg per day) aspirin can cause liver injury. People with bleeding disorders should not take any medication containing aspirin and should seek medical advice to discuss safe pain management options.
Ibuprofen
Ibuprofen is a non-steroidal anti-inflammatory drug used to treat pain, fever and inflammation.
As with aspirin, ibuprofen interferes with the clotting process and bleeding can be prolonged. It should be used with caution in the later stages of liver disease and with people on combination therapy or combination therapy (pegylated interferon and ribavirin). This effect on blood clotting is reversible and only lasts as long as the drug is circulating in the bloodstream.
Non steroidal anti-inflammatory drugs can in rare cases be toxic to the liver, this may occur early on in hepatitis treatment if ibuprofen is used regularly.
In all situations, the use of analgesics in persons with chronic hepatitis should first be discussed with your regular doctor. Your doctor is in the best position to advise you on the safest use of analgesics.