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January 11th, 2011
06:31 PM ET
Risks of NSAIDs backed in new studyNow there's even more reason to talk to your doctor about what kinds of painkillers you're taking. Supporting previous research on the subject, a large meta-analysis of 31 studies has found significant risks of cardiovascular events in people who take prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs). This research, published in the British Journal of Medicine, used a more sophisticated technique than previous studies, said Wayne Ray, professor and director of the Department of Preventive Medicine at Vanderbilt University and author of an editorial that accompanied the study. The analysis spanned studies including a total of more than 116,000 patients. Scientists looked at trials that had compared NSAIDs with other NSAIDs or placebo. Of the drugs studied, they found that ibuprofen (sold as Advil and others) carries the highest risk of stroke, etoricoxib (Arcoxia outside the United States; not sold in the U.S.) has the highest risk of cardiovascular death, and rofecoxib (previously sold as Vioxx in the United States, but it has since been withdrawn) carries the highest risk of heart attack. For certain drugs such as celecoxib (sold as Pfizer's Celebrex), the cardiovascular risk appears to go up with dosage. But the study did not consider the bleeding problems that can accompany usage of NSAIDs, said Dr. Jeffrey Berger, assistant professor of medicine at NYU Langone Medical Center in New York. This is an important limitation. Also, the study did not look specifically at patients who were at risk for cardiovascular problems already; although these people should be particularly wary of NSAIDs. That means that this data probably underestimated the risks of these drugs, Berger said. He also questions how much weight to put on the ibuprofen and stroke finding, because only two of the 31 trials looked at that question. Even though research has focused on prescription-strength doses of these drugs, the risks most likely apply to what's sold over the counter, especially given that a person can ingest the equivalent of a prescription dose by taking enough pills bought over the counter, Berger said. Of the NSAIDs examined across these trials, naproxen, the key ingredient in Aleve and other medications, is the safest, the study found. This drug still carries cardiovascular risk, but perhaps not as much as others such as ibuprofen, experts said. It seems that all of the NSAIDs seem to either prevent or raise the risk of cardiovascular events, and one theory is that naproxen has the best balance between the two, Ray said. Still, there is much more to be learned about naproxen; there has not been a large-scale clinical trial comparing it against a placebo for cardiovascular effects. A major study that could change current recommendations is called PRECISION, which compares celecoxib to prescription-strength doses of ibuprofen and naproxen in terms of cardiovascular risk. Participants are patients with arthritis who are at risk for cardiovascular problems, or who have had a history of them. The study began in 2006 and is scheduled to end in 2014. Bottom line: Talk to your doctor to assess the risks and benefits before you take NSAIDs, and make sure you disclose any heart risks you may already have.
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  About this blog
Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.
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I have found that aleve – naproxen had the best results for migraine headaches in place of caffeinated NSAIDS.
I've not had any migraines since taking Aleve. It's been amazing how fast Aleve responds to pain/headache. It's the only OTC that I use. Advil makes my tongue kind of swell and feel like aluminum foil.
Aleve works great on back pain for me!
Glad it works for you. Naproxen does NOTHING for my migraines.
Great heads up Dr. Gupta. There are a plethora of OCD's on the market about which little is known regarding their effect in rx dosages, in OCD reccomended dosages, and their use in conjunction with other drugs, both OCD and RX. With respect to soley RX drugs, the freqency with which they are prescribed with a dearth of information regarding their effect, long and short term is irresponsible. An excellent example of this is the widespread prescribing of SSRI's and the like by Primary Care Physicians who are largely unqualified to do so. In general, my point is there are a lot of gaping holes in the system of information management and dissemination with respect to the people
who need it most...the physician.
SSRIs, namely sertraline, are highly tolerable and efficacious with respect to other anti-depression medications. There is quite a lot of evidence out there to support their use as a first-line drug and the side effect profile is well known. Also, considering the low rates of diagnosis and treatment of depression, suicide consistently being in the top 10 causes of death in America (and under reported) and the stigma of psychiatrists in the general population, PCPs should be encouraged to screen and treat more people for depression and not simply refer them.
Depression kills, SSRIs rarely do
Being in a family medicine residency program myself currently, I can say that FM docs (PCPs) are extremely qualified to treat depression. In some populations, up to 30-40% of adult patients in family medicine clinics suffer from depression. In fact, there may not be one single condition that we see more in our clinic or that we spend more time learning about. We are trained in depth about the signs and symptoms of depression and its effect on other chronic diseases. We are uniquely positioned to understand exactly how depression impacts people in many different facets of their lives, in a much deeper and comprehensive way than psychiatrists in some instances. In our residency, we learn from both FM docs and psychiatrists regarding treatment- including but not limited to medication. We have a wealth of experience treating adults, pregnant women, and post partum women with depression and our clinic has a multidisciplinary approach that involves different mental health providers.
Your comments regarding how PCPs are "unqualified" to treat depression underscores the greater misconception of the general public toward Family Medicine doctors and our training. Specialists are undoubtedly indispensable members of the health care system, but in order to curb health care costs and improve both satisfaction and outcomes, primary care needs to return as the trusted backbone of our health care system. The public needs to be educated about this and allow us to do what we are trained to do.
Better a PCP than no one. Without a good health care plan the average person cannot afford a psychiatrist. In over 20 years of being maintained on a variety of psychiatric patients it has been my PCPs who knew the most about the drugs and were the least arrogant. I had the head of a psych ward in a major hospital put me on anti-psychotics for bi-polar II; for which it is not indicated; and told me it was not important that it raised my cholesterol despite the fact that I had extremely high numbers aleady. Other pshrinks have been horrified at this yet they turn around and do equally stupid things. There likely are lots of good psychiatrists. I have never met one. The main point, though, is that most people in the US cannot afford a psychiatrist and trying to get your plan , if you have one, to okay one is an awful experience. I have found PCP to be open to learning more and happy to work with you rather than on you.
As an RN, I have watched many people lose access to the pain medications that were helping them tremendously. My mother who suffers from sciatica and has very limited tolerance for synthetic narcotics (nausea allergies) has lost access first to vioxx and now to darvocet, and is now in horrible pain with virtually no relief. At 90, I can assure you she is not worried about their cardiac risks as opposed to living in chronic pain.
The obvious solution is barring imminent safety issues, is to let patients make an INFORMED decision with the risks fully disclosed as to whether or not they wish to incurr them rather than to be on a roll to get everything off the market.
Losing darvocet for my very worst days has really brought my quality of life down, and I'm only 40. Percocet does almost nothing for me.
First off, I have to apologize to Dea since I meant to reply to her and instead hit the 'report abuse' button. Sorry. Regarding darvocet . . . I know the drug will help some people, but in the vast majority it was shown to be little better than tylenol alone, and in larger doses it really did cause some serious heart problems. The British took it off the market before we did. For a weak opioid effect, options include tramadol, or even ultracet (which is half the tramadol with a little tylenol). Vioxx was great (see below) but corporate greed killed that one. In general, our tools to control pain largely suck. Think of it: the #1 opioid in the USA's hospitals is morphine . . . which is 6000 years old. That's how much progress we've made. Mother Nature has made pain such an integral part of our bodies and our survival that trying to stop it is as difficult as trying to stop your heartbeat. We need pain to survive, so Nature won't let us stop it completely, even when the pain serves no purpose other than to torture us.
@Dean- I'm allergic to motrin and codiene, which is very similar to tramadol, and since vioxx and a few other good ones disappeared my options are disappearing fast. Tylenol works pretty well and gets me through the day, every once in a while I go in for a shot of toradol. Hopefully they won't discover that tylenol is bad for my brain or something. 😀
Since she's 90 and has nausea problems, why not try medical cannabis? People have good luck with very small doses for pain relief, and it reduces nausea for most.
My allergist said NSAIDs can trigger sinusitis. I stopped taking ibuprofun (generic, over the counter stuff) for my arthritis (I don't take anything now) and I noticed a decrease in sinus problems. It's too early to know if this is a coincidence, but I'm pretty happy with the results so far. Weather changes used to give me horrible facial pain, but I haven't had an episode since I stopped taking ibuprofen.
I also have a neighbor who went into kidney failure, a rare complication of ibuprofen. He wasn't taking it as suggested on the bottle – not too much – and after a few days had horrible side pains and ended up in the hospital for a week.
Katie, your friend with the kidney problem probably had a rare allergic type 'nephritis' reaction to the ibuprofen. It definitely can happen . . . and both naprosyn and ibuprofen can also trigger a very rare but horrible, HORRIBLE and deadly skin reaction called Stevens-Johnson. So even over the counter medications can rarely have disastrous results. The thing is, millions of doses are taken by millions of people every day . . . so no matter how rare a reaction is, it is going to occur sometime or other every year.
I mean he wasn't taking too much, not as much as suggested on the bottle.
I guess it's a good thing excedrine is the only thing that works on my chronic pain. I already have a blood disorder that raises my chances of heart attack and stroke, don't need the meds to add to the problem.
Excedrin is a mix of acetominophen (Tylenol), aspirin and caffeine. Whatever risks those ingredients have will be the same for excedrin.
NSAIDS are simply the wrong solution to chronic joint pain. What has worked for me, and thousands of others, is a combination of: 1) Injections of proliferants into ligaments and/or joint capsules, and 2) flexibility exercise. See "The Lancet",
July 18, 1987, pp 143-146, http://www.ncbi.nlm.nih.gov/pubmed/2439856
Doesn't this presuppose that there is some cartilage left?
Not everyone has the same joint problem as you do. For some of us who have inflammatory connective tissue diseases, an ANTI-inflammatory is the best possible choice, because after that, our next option is systemic steroids.
Naproxen didn't work for me at all. Ibuprofen is the only thing that helps my joint pain and inflammation before they start me on steroids.
Medication choices are not one-size-fits-all.
What's fascinating with all the furor over Vioxx and then Bextra, is that these cardiovascular risks have been known since the late 1980's, when in JAMA and other journals noted that taken daily, NSAIDs raise blood pressure in people with hypertension. Given that a population increase in BP of a mere 3 mm Hg translates to a 30% increase in heart attacks, of course daily NSAID usage will increase cardiovascular deaths. Duh. So why, then, all the surprise and public outcry in 2004 with Vioxx? First, Vioxx was a nasty culprit in increasing BP, as bad as diclofenac (hey wait . . . isn't diclofenac still on the market? Why didn't the FDA take diclofenac off the market? Answer: Because it's a cheap generic, and killing people with a cheap generic drug actually SAVES Medicare dollars . . . just ask David Graham at the FDA!). The other reason Vioxx caused such outcry was the greedy company Merck hiding data from the public and doctors and wanting the drug to be used every day long term. Heck, in hospitals, us docs use an injectable NSAID called ketorolac (toradol) which is limited to only 5 days of use because of stomach ulcer risk. Vioxx should have been similarly limited, and it would have been a GREAT drug for acute pain. But no . . . Merck was greedy, and wanted it used daily for years. And Merck paid the price for their avarice. Meanwhile a great drug for short term use is gone. Look, NSAIDs are good drugs when used in limited doses for limited times, the same as opioids (narcotics). It's the high dose daily use that's the problem. Ah, well, Sanjay and the rest of the media need the yellow journalism approach to sell ad space on TV and here, so let them inflame the public with statements of excess.
I cannot take NSAIDs. I have tried them all from IBUProfen, Aleve, prescription Mobic, Celebrex, Vioxx. and others. I end up with the least of heart burn to stomach pain, bleeding, anemia, bruising, high blood pressure, swelling in my feet and ankles. I have arthritis and I am fairly young. My father was a heart patient with a pacemaker/defib and was doing really well, even had had a hip replacement and did not take pain medicine, he had injured his foot and his foot doctor gave him celebrex and within about a month he had severe swelling and congestive heart failure and died. It has never really been proven that celebrex was to blame, but you know how your family members health is and how it changes if you are close to them and especially if they have been through the above things. I am not trying to be negative, but I am just saying. I really wish I could take something myself for inflammation to relieve the pain, but right now there is nothing on the market, so I don't.
Have you tried flax seed oil (capsules)? works for me
So if I understand this article correctly, the study was useless but besides that, it was good. But talk to your doctor so you can explain this to him, because he's way too busy to try to figure it out.
Side effects include slow painful death, uncontrollable flatulence, random periods of deep sleep followed by grunting and snorting. If you notice that you're paralyzed, or have stopped breathing, reduce the dosage. Erections lasting 4 hours should be videotaped. Call now for a free 30 day supply.
Side effects include . . . uncontrollable flatulence, random periods of deep sleep followed by grunting and snorting.
OH NO! I think I have this! Help!
Great consumer advocate angle on the NSAID meta-analysis article:
Although it was removed from the US market by the FDA in 2004, please note that Vioxx is a brand of roficoxib, not eocoxib.
All the best,
Chip
Hi Chip, that was a typo and it has been fixed. Thanks!
Elizabeth Landau,
CNN.com
Since I am on coumadin, I take no nsaids at all. If my pain gets too severe I take ONE Indomethacin in the evening very rarely, and the inflammation is alleviated. By rarely I mean perhaps one capsule over several months. With nsaids you also get a rebound effect, which means more frequent episodes of pain.
I have been taking DOLOBID. which is an nsaids, since 1997, have had always good results for my arthritis, and have no bad results. I can always tell when I have forgotten my dose since the pain gets worse. Ny doctor always checks my liver, heart, etc and I have basically a good report and he has never told me that I need to stop. I have tried others, but always seem to go back to DOLOBID.
I use Aleve for that time of the month. It is the only thing that keeps me asleep all night. Everything else wears off at about 4 or 5 am.
Medication decisions should lie with the patient and his or her doctor. If a medication is effective at treating a certain condition, then the patient should be presented with the possible risks and allowed to choose whether or not to continue the treatment. All medications carry some risk; if we pull them because of this, we would end up pulling them all...
I had a reaction to Celebrex in 2000 that caused permanent kidney damage. I was only 31 at the time. I can no longer take anti-inflammatiories (other than steroids). This limited my options for pain control dealing with arthritis and migraines. Drugs like these need be prescribed under careful supervision!
i take indomethacin on a regular basis for my pain and swelling. not seeing anything said about side effects on this nsaid. anything different with this one? it has been a lifesaver for me. don't have to take near as much of my lorcet as i did before going on this drug.
I wound up with ulcerative colitis at 25 years old as a result of taking NSAIDs. I also have severe arthritis in my spine, and I relied on NSAIDs to function on a daily basis because doctors are so afraid of prescribing painkillers that actually work due to the severely overblown risk of addiction.
Even now, it's tremendously difficult to find effective pain management, despite the fact that I have a wonderful doctor who does. It only took me permanently destroying my intestines (I will probably need my colon removed at some point) to have them take my pain seriously. Numerous studies have shown that only three percent of people prescribed narcotic painkillers go on to abuse them, which means that 97% don't. Math obviously isn't the DEA's strong point. They are far safer and effective than OTC (and prescription) NSAIDs. The DEA needs to leave medicine to the physicians.
Medical marijuana. No known lethal overdose levels, and there are safe ways to administer it that don't increase the risk of breathing problems.
I'm allergic to marijuana. What would you suggest instead?
While there's an extremely small chance of complications with any medication, Ibuprofen is my choice for NSAID. In addition to pain relief, for which most NSAIDs are commonly used, it can also offer significant anti-inflammatory benefits to large body structures at somewhat higher doses. When treating an injury that will likely benefit from reduced inflammation, such as joint irritation, tendonitis, an bursitis, ibuprofen can be an excellent (and almost always safe) way to solve the problem quickly and without the use of other, more powerful drugs. Compared with other common NSAIDs, ibuprofen offers the best balance between pain relief, anti-inflammatory action, and risk of complications for me.
http://www.NutritionPerfected.com/np-blog.html
For chronic back and bunion pain, I have been using Turmeric capsules for about 3 months now (720mg 3X per day). There are no known side effects. They are not recommended for people taking anti-coagulants. They are inexpensive and work wonders compared to any other OTC pain killer I have tried. Within just a couple of days my bunion pain was completely gone and I have had that pain for several years. My lower back pain has decreased significantly. They have been studied for their natural COX2 inhibitors (anti-inflammatory), but do not have a negative affect on COX1. Please research it and consider trying it.
People with moderate to severe pain can start popping pills without paying attention to toxicity levels. With Aleve higher toxicity levels are easier to reach than with Ibuprophen.
Sounds like were living in a pharmacy!!! Remember that pain is a symptom and you will never fix it with a pill. Find the cause and don't cont to find excuses. The answer is out there, whether in exercising, increased H20, decrease food allergies, accupuncture, chiro, massage, etc.
Pain is like the engine light on your car-listen to it and fix the problem, don't just turn the light off with drugs.
No, pain is not like an engine light.
I agree, drugless. we take one pill to try and cure something and before long we are taking another pill to try and cure what that other pill caused without even knowing sometimes what the first problem was exactly....it is definitely a pill-popping society!
This is another reason why pot should be made available for medical reasons. No side affects none of course the studies here in the us are biased. in europe they are more open and they have not found one side affect. It is effective in relieving pain. I know some here will site all these things as to how bad it is. It is propaganda even former surgeon generals have stated it is a good medicine. Look it up for your self ... this is just my opinion.
Best OTC combo for pain = two 500mg acetaminophen + three 200mg ibuprofen.
These studies are comparing NSAIDS to NSAIDS. They don't mention the risks of taking these compared to switching to acetaminophen or other products. This is simply an article stating that someone analyzed a group of 31 studies that were already conducted previously and created their own article of the research and made a headline. The result is to TALK TO YOUR DOCTOR. Making your own decision about what to take in these situations (especially when you are taking prescription medicines) may lead to further complications.
There are complications with most pain medicines: liver complications with acetaminophen, kidney complications with ibuprofen, and gastric along with cardiovascular complications with other nsaids. Your doctor knows what your body is best compatible with based on your history and can help you decide.
If you have chronic pain, you should be working with a medical professional to get the support that is required to regain your health.
I quit using anything but an occasional aspirin years ago.
Does anyone know why Vicodin is still made with Acetaminophen and not Ibuprophen or Naproxin?. Acetaminphen can be so damaging to your liver in high doses or with alcohool... it amazes me that it's so highly prescribed in this country.
I never felt like opiates really dealt with actual pain anyway...more like euphoria that distracts from pain. But to each his own.
I know people that have to remove the tylenol from Vicodin through a cold-water extraction because of potential liver damage. One friend has resorted to carefully-dosed poppy tea because it's easier, cheaper and safer for long-term pain. But obviously all opiates carry addiction problems....
FM MD & others,
I know something about psychotropic medications because I suffer from manic depression
(also called bipolar disorder) and have taken SSRIs for over ten years.
In my experience, PCPs & FMs do not know enough about mental illness to try to treat mental illnesses by themselves.
All antidepressents can trigger mania, which
While FM MD means well, I urge anyone who feels depressed to see a psychiatrist.
If you had a sore throat or a broken bone, would you see a psychiatrist? Probably not.
Naproxen has never worked for me in any way. The pain is still there; Naproxen is useless! Nice to see the Aleve flacks are out in force here. Don't believe the hype. Good old ibuprofen..it may cause bleeding, but it really works. As with anything, people: moderation!
Why is there no mention of Aspirin? I take lots of aspirin (which can cause stomache bleeding, but I have never had a problem) for my disc/nerve pain, arthritis and migraines. It also has many protective benefits like decreasing the incidents of heart attack, stroke, pms, ovarian and colon and breast cancer. I never see it included in these NSAID studies and it is an NSAID.
I just finished going "cold turkey" after 19 months of opiates to treat the pain caused by a broken rotator cuff that cannot be repaired. Naproxen was the only drug that would help me. I am a high risk cardiac patient with a diagnosis of congestive heart disease. All my doctors know and agree that two generic Aleve in the A.M. and two in the P.M. will help me. I am 66 year old gentleman that also suffered through two years of painful chemotherapy for Non-Hodgkin's lymphoma. Find what works for you and discuss it with your physicians.
Please site the research article.
Yes to flax seed oil, and especially if taken with cottage cheese. Check out the research of a European researcher nomimated for the nobel prize, multiple times who not only suspected it was helpful for joint pain but also felt it cured heart disorders and cancer. She was scorned for her work in Europe where she practiced her cure... and for 100's of patients who gained benefit. A small book has been written about this-don't quote my spelling but I recall her name as Dr. Ana Asland.
Bottom line: if you need calories every day... all of us, and you would like to try her suspected remedy for many ailments, you don't have much to loose. Personally I love the taste of flax seed oil. Not the case for others, but now if you look at your local health food store, or ask, you will find lemon and cinnemon flavored varieties, which still have the same positive health properties. I must also mention the single most positive thing that all Doc's could do for their patients. Have them read, or just give them a copy of the little paperback book by Judith Shaw on Transfats in your diet. I am making specific reference to the oil in our diet that has been modified in a process of hydrogen being pumped into it at high pressure and temp, to cause a permanent modification to the molecule, which is not found anywhere in nature, and which can be metabolized in our bodies. Her book is a fun read about the history of how this came about in our society... very understandably so, during the early 1900's. This molecule will deposit into your joints, and other places... won't go on to depress you. A great book for everyone... period!... for all types of problems in your body that you can not explain.
I buy this and give it away often, for my friends and family. Many will not care about this, but it is a key piece of the puzzle, in my humble opinion.
Sorry for my typo- The transfat molecule- can not-be metabolized in the human body. It deposits. The alternative, by the way, is the natural oil that has not been modified. That oil will have a shorter shelf life. It will not make foods taste sweeter, as does the transfat oil. In other words, it is not as profitable for the food companies to sell.
The real oils will however, be properly metabolized in the body... so when it comes to this... who cares about the cost, or the profit to food companies.
The studies fail to mention if these people were screened for cardiac risks prior to taking nsaids and also the patients overall other risk factors such as diet,smoking etc.Celebrex is the most study nsaid on the market and its safety profile for cardiac events has been very low in comparison to other nsaids.I am not putting much stock in this study.Also i am will to bet the ones who had cardiac events were the older generation folks...
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While there are many ways to support back pain relaxation yoga is one of the best methods. I love this site.
I used Arcoxia and it gave me the power to move in one single tablet per day ,all the other NSAIDs I used before didnt relief my arithritris pain and since 8 month no side effect although i am hypertensive my blood pressure remained controlled .
Arcoxia I cant live with out it !!!!
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What about AminoActiv? It's an anti-inflammatory that uses amino acids naturally found in the body to relieve pain. University studies have shown it to be as effective as OTC NSAIDs, without the side effects.
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