The opioid crisis is getting a lot of attention these days, but the highly-addictive prescription medications aren’t the only class of pain relievers causing serious health problems in the U.S.
Non-steroidal anti-inflammatory drugs (NSAIDs) may be an even more widespread threat to the general public. Eaten like candy by millions of Americans to relieve aches and pains, NSAIDs are generally considered to be relatively harmless, especially over-the-counter (OTC) varieties such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve). But they pose their own set of risks – including stomach bleeding, stroke, high blood pressure, and other cardiovascular hazards.
“I don’t think enough attention is given to this problem, especially among patients with an underlying medical problem that could be significantly worsened by even short-term exposure to non-steroidals,” says Dr. Michael Hooten, a pain medicine specialist at the Mayo Clinic in Rochester, Minn.
“Because they are widely available and have been marketed as being safe OTC drugs for so many decades now, we have become callous to their adverse effects. I’d suggest that if those drugs had to face the rigors of testing to be OTC today, they may not be allowed.”
NSAIDs work by blocking enzymes vital to producing prostaglandins, lipid compounds that sensitize nerve cells to pain due to inflammation. Prostaglandins also affect the fever-control center of the hypothalamus in the brain. That’s why NSAIDs can reduce pain and fever.
But prostaglandins also serve as vasodilators to open blood vessels, affect blood clotting and have various other metabolic functions. So when they are inhibited, pain and fever relief aren’t the only results.
“Non-steroidals have an adverse effect on the kidneys, particularly in people who already have a reduction in renal function due to diabetes or some other disease,” Hooten tells Newsmax Health. “These drugs also cause erosion of the gastric lining, which can set up gastric hemorrhage, a life-threatening condition. And they can contribute to high blood pressure.”
One prescription NSAID, rofecoxib (Vioxx), was pulled from the market in 2004 because it significantly increased risk of heart attack and stroke. Researchers subsequently found that all NSAIDs were associated with increased risk of cardiovascular (CV) events.
“This CV risk was dependent on how long the drugs were taken and the dose,” notes Dr. Bill McCarberg, past president of the American Academy of Pain Medicine (AAPM), on Medscape.com. “The higher the dose and the longer period of time taken, the more risk.”
That’s why experts recommend using the lowest effective dose of NSAIDs for the shortest period of time.
“The drugs are safer if used intermittently,” says Hooten, director-at-large of the AAPM. “Even in healthy people, problems arise when they’re taken on a regular basis, especially in the gastric tract.”
Since many NSAIDs don’t need prescriptions, a lot of people take them without consulting their doctor about potentially adverse reactions when used with other medications, such as some blood thinners and antidepressants. And seniors, who are the biggest users of NSAIDs, are more at risk because they are likely to have other health problems that could be exacerbated by the drugs.
“A safer option is acetaminophen, or Tylenol, which has no adverse side effects on the GI tract, kidneys or cardiovascular system when used at a safe dosage,” says Hooten. “But higher doses are associated with liver toxicity. The recommended maximum dose per day is 3,000 milligrams.”
You can also try to ditch the drugs entirely. Pain can be treated with acupuncture, chiropractic care, massage, essential oils, herbal supplements, analgesic salves, and other therapies.
“Most people take non-steroidals for aches and pains that are muscular and skeletal in nature, so regular daily exercise can help,” says Hooten. “Exercise strengthens muscles and helps keep the mobility and range of motion of the joints intact.
“The take-home message about non-steroidals is just because you can get them over the counter, don’t forget that they have very serious adverse effects.”
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