What is the best painkiller for gastritis?

Best Analgesic for Gastritis

Acetaminophen (paracetamol) is the safest and most appropriate analgesic for patients with gastritis due to its favorable gastrointestinal safety profile compared to NSAIDs. 1, 2

Rationale for Acetaminophen Selection

• Acetaminophen does not cause gastric mucosal damage, erosions, or ulcers, unlike aspirin and other NSAIDs, making it the optimal choice for patients with gastritis 3
• Acetaminophen can be administered at doses of 500-1000mg per dose, with a maximum daily dose of 3-4g to provide effective pain relief while minimizing risks 1
• Unlike NSAIDs, acetaminophen does not alter the gastric mucosal barrier to hydrogen ions or lower gastric potential difference, preserving gastric protective mechanisms 3
• Acetaminophen is generally well tolerated at recommended doses (≤4 g/day) in adults with gastrointestinal disorders 2

Risks of NSAIDs in Gastritis

• NSAIDs, including aspirin, are significantly associated with major upper gastrointestinal hemorrhage and should be avoided in patients with gastritis 3
• Short-term use of aspirin produces erythema, erosions, and occasionally ulcers in the gastric mucosa, which can worsen existing gastritis 3
• NSAIDs cause a dramatic reduction in the ability of gastric mucosa to generate protective prostaglandins, further compromising the already inflamed gastric lining 3
• Combined use of aspirin with another NSAID significantly increases the risk of gastrointestinal bleeding, over 10-fold greater than the risk among those not using NSAIDs 1

Dosing Recommendations for Acetaminophen

• For mild to moderate pain, acetaminophen should be administered at doses of 500-1000mg per dose 1
• The maximum daily dose should not exceed 3-4g to minimize potential liver toxicity risks 1
• For chronic use, limiting acetaminophen to 3g or less per day is recommended to minimize liver toxicity concerns 1

Alternative Options If Acetaminophen Is Insufficient

• If acetaminophen alone provides inadequate pain relief, antispasmodics may be considered as they rank second in efficacy for abdominal pain relief 4
• Tricyclic antidepressants at low doses may be considered for persistent pain not responding to acetaminophen, as they have been shown to be effective for visceral pain 4
• Topical analgesics may be considered for localized pain due to minimal systemic absorption and fewer drug interactions with the gastrointestinal tract 1

Medications to Avoid in Gastritis

• All NSAIDs, including ibuprofen, naproxen, and aspirin should be avoided as they can cause or worsen gastritis 3
• Combination products containing both acetaminophen and NSAIDs should be avoided to prevent gastric mucosal damage 1
• Opioids should generally be avoided for gastritis pain due to their potential to cause nausea, constipation, and other gastrointestinal side effects 4

Monitoring Recommendations

• If acetaminophen is used chronically, periodic monitoring of liver function is recommended 1
• Patients should be educated about the maximum daily acetaminophen dose to prevent inadvertent hepatotoxicity 1
• Patients with gastritis should be monitored for signs of gastrointestinal bleeding, especially if they have risk factors such as older age or history of peptic ulcer disease 1

By following these recommendations, pain in gastritis can be effectively managed while minimizing the risk of worsening the underlying gastric inflammation or causing additional gastrointestinal complications.