The bottom line

Be careful about which drugs you take. Aspirin is not benign.

Aspirin is one of the most commonly used NSAIDs, which are drugs used to reduce inflammation, usually temporarily. Many doctors even advise older patients to take baby aspirin to ward off heart disease. Here, I will argue that taking aspirin is a bad thing if you have chronic pain, and you might not want to take it at all (especially considering that there are many other anti-inflammatory alternatives, both natural and synthetic).

How helpful is aspirin for chronic pain?

In general, NSAIDs only show a very slight benefit for longer term chronic pain.

If the benefit is slight, it means that we really have to look closely at side effects and longer-term risks.

Is aspirin dangerous?

For many people with chronic pain, aspirin may not be worth taking. Let’s see why.

First, aspirin is quite likely to cause upper GI tract side effects when taken for longer periods.

Second, there may be some liver health issues.

One study looked at people with fatty livers and tested how leaky their intestines became after taking aspirin, compared to people without a fatty liver.

Both patients with fatty liver and without fatty liver had more stuff leaking through their small intestines after taking aspirin (note: at experimental doses, to induce a response).

But those with fatty liver had more leaking in their large intestine (aka colon) as well. Not only that, but people with fatty liver ended up having higher endotoxin levels (endotoxins are released when certain bacteria die). You don’t want these endotoxins to leak through your intestine wall and get into your blood, no sir. That would probably lead to your body having to fight said endotoxins and produce inflammation.

Now combine those results with this study, which showed that patients with fatty liver have more small intestinal bacterial overgrowth, and you’ve got a bad recipe for gut health–both small intestine and large intestine. (Note, however, that this study did not find an increase in intestinal permeability or endotoxin, but did find high inflammation levels).

Why is this important for chronic pain? Well, first of all, you want a healthy liver if you have chronic pain. People with chronic pain tend to take more medications than the average person. Drugs are detoxified by the liver. You don’t want a damaged liver to get more damaged.

Second, and perhaps more importantly, the liver controls much of the body’s metabolism. Screw up the liver, and you may have a hard time burning fats very well, you might be on the road to diabetes, and you might have a hard time dealing with disease because of these things. That is the path to the dark side. Systemic inflammation is tough to control, and is seriously implicated in some of the more confusing pain conditions.

These are only some of the things we know about aspirin’s disadvantages … I’ve also got a half-baked theory that taking too much aspirin can be bad in other ways. For example, Reye’s syndrome is a rare disease in children that is often associated with aspirin use, and can lead to anything from headaches and vomiting to death. Aspirin might be implicated in this because it can damange mitochondria–the energy powerhouses in our cells.

While normal doses of aspirin surely don’t do much in this regard, I need to do more research as to how exactly long term aspirin use affects our cells. Also, taking opioid pain killers makes you constipated, and you don’t want to be constipated at the same time that you have an overload of dead bacterial waste products in your gut.