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You probably have had a headache sometime in your life, and chances are you will take some kind of medicine to ease your pain. The medicine you will take will most likely be a relative of aspirin.
You may also have taken aspirin or its relatives for other problems, like inflammation or fever but did you know that about 80 billion aspirin tablets are taken per year for these problems, as well as many others? For example, millions of people take aspirin to help prevent heart attacks.
Aspirin is a member of a family of chemicals called salicylates
One of the first and most influential physicians, Hippocrates, wrote about a bitter powder extracted from willow bark that could ease aches and pains and reduce fevers as long ago as the fifth century B.C. In the 1700s, a scientist by the name of Reverend Edmund Stone wrote about the success of the bark of the willow in the cure of fevers with aches. With a bit of chemical detective work, scientists found out that the part of willow bark that was (1) bitter and (2) good for fever and pain is a chemical known as salicin.
It was a pharmacist known as Leroux who showed in 1829 that salicin is this active willow ingredient and your body converts this ingredient after it is eaten to another chemical, salicylic acid.
An Italian chemist by the name of Piria made salicylic acid, from salicin and for many years it was used in high doses to treat pain and swelling in diseases like arthritis and to treat fever.
A German chemist Felix Hoffmann, who worked for the chemical company Friedrich Bayer & Co. wanted to find a chemical that wouldn’t be so hard on your stomach lining; reasoning that salicylic acid may be irritating because it is an acid. He put the compound through a couple of chemical reactions that covered up one of the acidic parts with an acetyl group, converting it to acetylsalicylic acid (ASA). He found that ASA could reduce fever and relieve pain and swelling, but also believed it was better for your stomach and worked even better than salicylic acid.
Over the next hundred years, ASA would fall in and out of favour, and at least two new families of medicines would be derived from it, and innumerable research articles would be published about aspirin.
No one completely understands how pain works. Actually, a lot is known about pain, but the more we find out the more questions arise.
Pain is really something you feel in your brain. Let’s say you hit your finger with a hammer. The part of your finger that is damaged has nerve endings in it — these are little detectors in your joints and your skin that feel things like heat, vibration, touch, and, of course, big crushing shocks like being hit with a hammer. There are different receptors for each of these types of sensations. The damaged tissue in your finger also releases some chemicals that make those nerve endings register the crushing shock even stronger — like turning up the volume on your stereo so you can hear it better. Some of these chemicals are prostaglandins, and working cells in the damaged tissues make these chemicals using an enzyme called cyclooxygenase 2 (COX-2).
Because of the prostaglandins, the nerve endings that are involved now send a strong signal through nerves in your hand, then through your arm, up your neck and into your brain, where your mind decides this signal means, “HEY! PAIN!” The prostaglandins seem to contribute just a portion of the total signal that means pain, but this portion is an important one. In addition, prostaglandins not only help you to feel the pain of the damaged finger, but they also cause the finger to swell up and to bathe the tissues in fluid from your blood that will protect it and help it to heal. (This is a simplified version of the pain story.) This pathway works very well as far as telling you your finger is hurt. The pain serves a purpose here: It reminds you that your finger is damaged and that you need to be careful with it and not use it until it’s healed. The problem is that, sometimes, things hurt without the hammer or for any other good reason. Sometimes you get a headache possibly because your scalp and neck muscles are contracted from stress or because a blood vessel in your brain has a spasm. Many people have arthritis, which is swelling and pain in the joints such as the knuckles or knees, and this problem can not only make people uncomfortable, it can damage the joints permanently. And many women have pain in their abdomens during their periods, usually known as cramps, for no known useful reason. These processes appear to involve prostaglandins as well.
Aspirin helps these problems by stopping cells from making prostaglandins. Remember the enzyme, COX-2? It is a protein made by your body’s cells whose job it is to take chemicals floating around in your tissues and turn them into prostaglandins.
COX-2 can be found in lots of normal tissues, but much more of it is made in tissue that has been damaged in some way. Aspirin, sticks to COX-2 and won’t let it do its job. So by taking aspirin, you don’t stop the problem that’s causing the pain, like the tight muscles in your scalp, or the cramping in your abdomen, or the hammer-damaged finger. But it does “lower the volume” of the pain signals getting through your nerves to your brain, because Cox-2 can’t produce the prostaglandins that send the signal to your brain. Got it?
So how does aspirin know how to get to where the pain is? Well it doesn’t! When you take aspirin, it dissolves in your stomach or the next part of the digestive tract, the small intestine, and your body absorbs it there. Then it goes into your bloodstream and it goes through your entire body. Although it is everywhere, it only works where there are prostaglandins being made, which includes the area where it hurts.
As with almost all chemicals, your body has ways of getting rid of aspirin. In this case, your liver, stomach, and other organs change aspirin to… surprise! Salicylic acid! This chemical then slowly gets changed a bit more by the liver, which sticks other chemicals onto the salicylic acid so that your kidneys, can filter it out of your blood and send it out in your urine. This whole process takes about four to six hours, so that’s why you need to take another pill every 4 to 6 hours to keep the effect going.
The problem with the fact that aspirin goes through your entire bloodstream is that your body needs prostaglandins for some reasons. One place they are useful is in the stomach. It turns out another enzyme called COX-1 makes a prostaglandin that keeps your stomach lining nice and thick. Aspirin stops COX-1 from working (it keeps most prostaglandins from being made), and your stomach lining gets thin, allowing the digestive juice inside to irritate it. This is probably the biggest reason why aspirin and its relatives may upset your stomach.
Over the last few decades, it has been found that aspirin’s action of stopping prostaglandin production has effects on things besides pain, inflammation, and the stomach. Some types of prostaglandins cause tiny particles in your blood (platelets) to stick together to form a blood clot. By inhibiting prostaglandin production, aspirin slows down clot production. Although this can be bad, such as with a bloody nose, blood clots can be damaging as well, such as in causing heart attacks
Like all medicines, aspirin has side effects on your body that you don’t want. Like, if you hit your finger with a hammer and it’s bleeding, an aspirin may help the pain and swelling, but the wound may take longer to clot and stop bleeding. Also, it can be very upsetting to your stomach, especially at high doses.
Also Aspirin isn’t used these days in children with fevers since research has suggested that aspirin given to kids with flu, chickenpox, or other viral sicknesses may cause a potentially deadly problem called Reye syndrome.
For these reasons, chemists have found other chemicals closely related to aspirin that have some of its good effects and lack some of its bad effects. Ibuprofen and naproxen (Motrin and Naprosyn) also treat pain, swelling and fever, but they seem to have less of an effect on platelets than aspirin does. These medicines are called the non-steroidal anti-inflammatory drugs (NSAIDs) because they decrease swelling but they aren’t steroids, which are the most potent anti-inflammatory chemicals we have. Another family of medicines related to aspirin includes acetaminophen (Tylenol), which decreases fevers and pain, but it doesn’t affect either swelling or your stomach as much as the true NSAIDs do.
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