Your questions about pain relief

By Elizabeth Landau
CNN.com Health Writer/Producer

We received an enormous reader response last week regarding the study on non-steroidal anti-inflammatory drugs and cardiovascular death. That study found that there were 769 deaths out of 1,028,437 relatively healthy people who took NSAIDs – a small but significant risk – and that the risk went up with higher doses.

CNN gave some of your questions to Dr. Eugene Viscusi, director of pain management at Thomas Jefferson University in Philadelphia, Pennsylvania. Here's what he had to say:

1. How would you compare prescription strength NSAIDs with nonprescription strength in terms of cardiovascular risk?
“It really seems to be based on duration,” he says. "The higher the dose, and the longer you’re on it, the higher the cardiovascular risk," One single dose does not increase the risk of heart problems, he said. But if a person is already at risk for heart attack or other complications, a doctor might not prescribe them a NSAID, he said, or might have to pay special attention to negative effects. But the bottom line is "I wouldn’t want readers to get the idea that a few doses are likely to cause a severe and profound risk," he said.

2. Do you think that the culture of over-the-counter painkillers is dangerous?
It’s not so much abuse that's the problem with over-the-counter medications; it’s misuse, he said. Some that has to do with ambiguous labeling. Most people don't know, for instance, that Pepto Bismol contains aspirin. “ I believe it’s the combination agents in over-the-counter medications that creates a lot of the confusion that leads to unintended overdose,” he said. Combining drugs can be dangerous, especially if you don't know exactly what's in multiple medications you are taking at the same time.

3. I have been told to take an aspirin before taking ibuprofen because it counteracts the clotting agents in ibuprofen, which can lead to stroke.
Theoretically, if you take an anti-platelet drug such as aspirin, you might reduce your risk, he said. But many patients who are taking low-dose aspirin for cardiovascular event prevention will want the anti-platelet effect, and the ibuprofen may cancel it out. For those patients who have a risk factor, this might not be the class of drugs you would use as the first line aid, he said.

4. Should I not take ibuprofen, and take something with naproxen instead, since the study found less risk with it?
If you are the average patient who doesn’t have a cardiac risk profile, then your risk is minimal, he said. The bigger question is: Are you going to be on these drugs on a long-term basis? It’s not the occasional “I have a headache or a fever, and take it for 24-48 hours,” he said. “I can’t say that we need to scare patients who have a moderate risk profile, and say, ‘Just don’t take non-steroidals.’” The vast majority of patients do very well with them, but their cardiac risk should be assessed, and the higher the baseline risk, the less likely they should be on these drugs for a prolonged basis, he said.

5. I take ibuprofen on a monthly basis for PMS but have a genetic risk of heart attack. Is it OK?
You’re dealing with a relatively young woman – if she has long-standing high blood pressure and a cardiovascular disease or, worse yet, had blood clots in her legs, her risk is higher, he said. But it’s still a relative risk, he said. It’s not a "yes or no" phenomenon – the patient and doctor should evaluate it and decide what's best based on health and family history.

A side note: Many patients who took Vioxx for arthritis were distraught when the drug came off the market because of cardiovascular risks, he said. In fact, some said they would have accepted the risk of that incredibly potent NSAID, because it worked so well for their pain.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

Post by: Elizabeth Landau - CNN.com Health Writer/Producer
Filed under: Heart

soundoff (19 Responses)

Lesa

I have been taking an NSAID for 6 years for the effects of an accident...not so much now but it has been long term. I was never told that this raises the risk of heart attacks/strokes. I'm not sure I woulkd be able to function during cold weather without this drug, nabumetone , the generic for Relafin. Should I be concerned? At 2250mg per day on bad days, I assume this is not a good thing?

June 17, 2010 at 21:23 | Report abuse | Reply
Phyllis L. Reed

I am one of the ones who benefited from Bextra, and not having any cardiac problems, was very disappointed when it was taken off the market. Once the warnings were publicized, doctors could have used their judgment as for which patients they could prescribe it.

June 17, 2010 at 21:59 | Report abuse | Reply
Daniel

Wait, what clotting effects of Ibuprofen? Ibuprofen has the opposite effect, acting as a blood thinner, which is why surgeons tell you not to take it for a week before you have surgery.

June 18, 2010 at 00:30 | Report abuse | Reply
benet,b.a.,m.s.,r.m.,s.m.,m.s.m.t,mph,mba,ph.d,o.,frsm

what specifically are the qualifications and credentials of Dr. Eugene Viscusi, that makes him such an "expert" in the field of pain management?

June 18, 2010 at 01:15 | Report abuse | Reply
Janna

I always run into trouble bcause I have to take Coumadin. That eliminates NSAIDS for me, and because I also have liver problems< due to sarcoidosis, I try to avoid Tylenol as much as humanly possible. So as a person who suffers from chronic pain, Percocet and Vicodan are out. I ended up taking the lowest does of morpine possible. It's not a all cool, being that morphine, when i take it, makes me immediately want to sleep.

June 18, 2010 at 06:52 | Report abuse | Reply
jeff

I'm a Bayer user but I took 2 ALEVE tablets in October because of some inflammation in my left foot. Within 3 minutes I was down. 5 minutes later I had the fire dept there. I think they lost me twice before the EMT's got there. I spent a few hours in hospital from those – but survived. But only because I was treated. If I was alone that night, I wouldn't be here now.

I'm just sticking to Bayer.

June 18, 2010 at 07:19 | Report abuse | Reply
Pittsburgh

I took an OTC-level dose of ibuprofen for back pain for several months. I'm in my late 30s with no family or personal history of heart disease. The next time I went to my MD for a physical she said my BP was high (also high on re-check) and that ibuprofen definitely causes that if you take it for a certain period of time such as the several months I did until the back pain resolved on its own. Now I'm on a BP med and not happy about it. Needless to say the next time my back acts up I'm going to suck it up (or maybe get physical therapy) instead of taking ANYTHING.

June 18, 2010 at 08:43 | Report abuse | Reply
juanbojab

Vioxx was the best medication I have ever taken. if it had the same side effects as advil, tylenol or aleve, why not just tell people of that fact instead of removing it? we keep taking those medication yearly by the truck loads.

June 18, 2010 at 11:59 | Report abuse | Reply
juanbojab

I should say, lawyers and some people just want to see a deffect in every medication which could help or even cure people, but once a tiny data comes out in a negative way, they flock the judicial system with law suits and everything one user is going through is immediately attributed to that medication. they could be the most unhealthy person before that medication link to a side effect and from there on lawyers will run the company out of bussiness with extraordinary absurd claims. some of use lose the venefits of the medication for lawyers' abuse of the system and people's greed. nsaid will not kill you, just use it as directed and if you can't read, then i am writing this for nothing and you will keep using pills as you want-not good-or ask a doctor and follow verbal directions on this.

June 18, 2010 at 12:13 | Report abuse | Reply
Tsandi Crew

No one I have asked has ever heard of Ibuprophen causing blood clots. Where does this information come from?

June 23, 2010 at 13:00 | Report abuse | Reply
Alfadan

I have had chronic and at times crippling arthritis for about 40 years and during that time I have taken every NSAID available. Everything I have read says the same platitude, "take as little as possible, for as short a time as possible." That doesn't apply to millions like myself who HAVE to take these drugs daily to function. Can anyone tell me what is a high dose, low dose and how long is long? I hear and read contradictions everywhere, including the alarmists on national television who I think are being paid by the drug companies.

Diclofenac works great but is supposd to kill me sooner. In a 2004 study for Vioxx, Aleve raised my chance for a heart attack by 50% so I stopped that until recently when another study said it was the safest. I don't believe anyone or anything I read anymore. After years of Indocin, Motrin, Naprosyn, and diclofenac, I'm settle into about 700mg of Aleve a day. I hope I'm around to see some more studies on pain relievers so that I know what I have been doing wrong and what I should have been doing all these years.

June 27, 2010 at 09:45 | Report abuse | Reply
Tsandi Crew

I see the article has changed since I asked my question.

July 1, 2010 at 09:43 | Report abuse | Reply
Noneya

Everyone here has an alternative–That being Narcotic pain killers. The recent stigmata surrounding them is insane. They are the most effective AND least lethal of them all. Unfortunately, they get a bad rap from people who abuse them.

July 10, 2010 at 13:03 | Report abuse | Reply
SoothingMeadow

Here is some help with getting pain relief.

http://www.naturalcancerpainrelief.com/

January 24, 2011 at 19:00 | Report abuse | Reply
Donald Howard Smith

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September 2, 2011 at 09:37 | Report abuse | Reply
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Your questions about pain relief

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