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It may seem obvious. You have a headache, you reach for acetaminophen. You start feeling menstrual cramps, you take a few ibuprofen. You wake up with stiff, arthritic fingers, you swallow some aspirin or naproxen.?

But are the rules for taking over-the-counter (OTC) pain relievers any different if you¡¯re a cancer patient on active cancer treatment? Are there any circumstances in which you should not take them??

Read on to find out.??

Over-the-counter (OTC) does not mean harmless?

The most important thing to know about OTC pain relievers is: just because you can get them without a prescription doesn¡¯t mean they¡¯re harmless. OTC medications can still pose very real risks, especially if taken inappropriately. That¡¯s why it¡¯s so important to educate yourself and ask questions if there¡¯s any confusion.

Non-steroidal anti-inflammatory drugs (NSAIDs), for instance, are a group of common OTC pain medications. Some examples of NSAIDs include:

• Aspirin?
• Ibuprofen?
• Naproxen??

While NSAIDs can be very useful, they can also be hard on the kidneys and gut. NSAIDs can be so irritating that it¡¯s possible to develop stomach ulcers after only a few doses. That¡¯s why I usually recommend taking NSAIDs with food.

Aspirin also acts as a blood thinner, which can be especially dangerous if you have low platelet counts. Platelets are the blood component that helps blood clot and prevents uncontrolled bleeding.

Many cancer patients have low platelet counts from time to time, especially if they¡¯re on active treatment with chemotherapy. But in those situations, even everyday accidents, such as cutting your finger while cooking or falling and scraping your knee, can lead to more bleeding than expected. ?

Pain is a message: Don¡¯t ignore it?

Another important thing to remember is that pain is often a message. It¡¯s your body¡¯s way of telling you something¡¯s wrong. So, it¡¯s important to pay attention to it and let your care team know if you¡¯re experiencing any pain, especially if the pain is new or getting worse over time.

It may seem harmless to take an OTC pain reliever to help with small things like a mild headache or a stubbed toe, but many of these medications are also antipyretics, or fever reducers. That means they can temporarily mask a fever, which can be dangerous for cancer patients on active cancer treatment.

Many chemotherapies also suppress the immune system, which prevents your body from mounting the same defense against infections that it normally would. A fever is often one of the only ways your body can still respond and warn you that an infection is brewing. But if an OTC pain medication is masking that fever, you may not even know you have an infection until it has grown into something much more difficult to control.?

That¡¯s why I tell patients to always check their temperature before taking any fever reducers, just to make sure they don¡¯t have a fever already. I also recommend that they tell their care teams about any OTC medication use. There are instances in which a prescription-strength medication may be more appropriate than an OTC medication for pain management.