Many people rely on their morning coffee to get going, and do not feel able to address the world until they’ve had at least one cup. Caffeine, the active ingredient in coffee and many other beverages, has been called the most widely used psychoactive substance in the world. It has been suggested that coffee increases the risk of some health problems, and reduces the risk of others. Some will say that caffeine increases pain, some that it helps with pain. The truth is a little more complicated …
Caffeine acts in a number of ways in the body. One of the ways it works is by antagonizing, or blocking, the actions of adenosine. Adenosine promotes sleep and relaxation, causes dilation of blood vessels, slows the heart rate, increases appetite, and may reduce inflammatory processes. Consequently, caffeine causes wakefulness, increased heart rate, increased blood pressure, and possibly increased inflammation. Caffeine can also increase stomach acid and speed up bone loss in osteoporosis. High levels of caffeine can result in tremors, reduced coordination, insomnia, anxiety/panic.
Interestingly, low levels of caffeine may be helpful with pain, especially headache and migraine pain. Several over-the-counter pain medications contain caffeine, usually 50-65 mg per tablet (for reference, a cup of coffee usually contains 80-175 mg), and research suggests that caffeine does provide moderate pain relief, especially when combined with other medications like acetaminophen (Tylenol), aspirin, or ibuprofen. Some research indicates that moderate to high doses of caffeine (100-800 mg) can improve muscle pain from exercise, and can improve endurance when taken before strenuous aerobic exercise. This effect appears to be more pronounced in people who do not usually drink coffee or other caffeinated beverages. Side effects were significant with higher caffeine doses.
Caffeine is sometimes associated with increased pain. Although occasional use of caffeine is thought to be helpful in treating headaches and migraines, another type of headache is made worse by regular caffeine use. Recently, specialists have identified “medication overuse” headache, which is a result of using headache medications every day. This can happen with any pain medication, including caffeine. The headache initially improves with the medication, but then returns, often worse than before. The only treatment is to stop using pain medications, but it can take a few weeks for the headaches to subside.
Caffeine withdrawal is a common phenomenon in people who abruptly reduce or stop their caffeine intake. Symptoms of caffeine withdrawal can include severe headache, as well as sleepiness, irritability, depression and joint pain. If you decide to reduce or stop caffeine, you should do so gradually to avoid these symptoms.
Other ways that caffeine can cause increased pain are by causing insomnia or other sleep disruptions, and by increasing muscle tightness and cramping. These effects are more likely to happen with higher caffeine intake and with caffeine intake later in the day. Research has not really supported the idea that the risk of developing chronic pain is increased by caffeine, but high caffeine intake is associated with other behaviors and conditions that are known to be associated with chronic pain, such as poor sleep, nicotine use, alcohol use, and anxiety/panic disorders.
It is likely that caffeine in moderation is not harmful, and may even be helpful, but even low doses may be harmful in people who are sensitive. If your caffeine intake is more than one or two caffeinated beverages a day, it might be worth a trial of reducing or discontinuing caffeine for a few months to see how you do. Even if your caffeine intake is low, stopping for a few weeks or months might be beneficial. You should be aware, however, that this can change how your body handles other medications, including medications for asthma, sleep, depression, arthritis, seizures, alcoholism, and others, so talk to your health care providers if you change your caffeine intake.
At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.