About 29 million Americans use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain.
Every year in the United States, NSAID use is attributed to approximately 100,000 hospitalizations and 17,000 deaths.
In addition, the U.S. Food and Drug Administration recently strengthened its warning about risks of non-aspirin NSAIDs on heart attacks and strokes.
While each over-the-counter and prescription pain reliever has benefits and risks, deciding which one to use is complicated for health care providers and their patients.
In a new study, researchers write a review to provide guidance to health care providers and their patients in their clinical decision-making.
The review addresses cardiovascular risks and beyond, which include gastrointestinal and kidney side effects of pain relievers.
The research was conducted by a team from Florida Atlantic University.
The team examined the benefits and risks of over-the-counter and prescription drugs for pain relief such as aspirin, ibuprofen (Motrin or Advil), naproxen (Aleve), and prescription drugs such as diclofenac (Voltaren), a non-aspirin NSAID, and selective cyclooxygenase-2 inhibitors such as celecoxib (Celebrex) as well as acetaminophen (Tylenol).
NSAIDs include aspirin, traditional non-aspirin NSAIDs such as ibuprofen, (Motrin or Advil), naproxen, (Aleve) and diclofenac, (Voltaren) as well as selective cyclooxygenase 2 inhibitors (COXIBs), such as celecoxib (Celebrex), and acetaminophen (Tylenol).
The team found all of these drugs have benefits and risks.
Aspirin decreases inflammation as well as coronary events and stroke, but increases gastrointestinal symptoms and bleeding, however, without adverse hepatic or renal consequences.
Non-aspirin NSAIDs decrease inflammation but have been linked to adverse major coronary events and stroke with long-term use as well as major upper gastrointestinal and kidney side effects, as well as electrolyte imbalances such as high sodium or potassium and even heart failure.
Cyclooxygenase 2 (COX2) inhibitors were developed primarily because of their more favorable gastrointestinal side effect profile relative to aspirin and traditional non-aspirin NSAIDs, but confer adverse cardiovascular as well as hepatic and renal effects.
Acetaminophen has no clinically relevant anti-inflammatory properties and accounts for more than 50% of drug overdose-related liver failure and about 20% of liver transplant cases, as well as kidney disease.
The findings suggest that health care providers and their patients should make individual clinical judgments based on the entire risk factor profile of the patient.
The factors in the decision of whether and, if so, which drug to prescribe for relief of pain and inflammation, should not be limited to risks of cardiovascular or gastrointestinal side effects.
These considerations should also include potential benefits including improvements in overall quality of life resulting from a decrease in pain or impairment from musculoskeletal pain syndromes
The lead author of the study is Manas Rane, M.D., a third-year internal medicine resident in FAU’s Schmidt College of Medicine.
The study is published in the Journal of Cardiovascular Pharmacology and Therapeutics.
Copyright © 2019 Knowridge Science Report. All rights reserved.