Cycling Wed: Pain relief can be bad for the heart

For those who choose athletic training as an avocation there was important medical news released this week.  It has to do with which medicines we use to relieve our aches and pains.

Sadly there are few good options.

The report was a huge (116,000 patient) meta-analysis (a statistical review of previously published trials) published in the British Medical Journal.  The Swiss researchers reported on the cardiovascular safety of the commonly-used pain relievers, NSAIDs (Non-steroidal anti-inflammatory drugs; ibuprofen, naproxen, diclofenac, and Celebrex).

The news was bad.  And it was the heart this time.

Since 2004, when Vioxx was pulled from the market because it markedly increased the risk of heart-attacks, many believed that other NSAIDs were safe—that this was a Vioxx effect, not a class effect. This trial strongly refutes the idea that any NSAIDs are safe.  The stand-out in this trial was ibuprofen, which increased the risk of stroke three-fold.  The best of the worst looked to be naproxen (Aleve).  The widely-touted Celebrex increased cardiovascular risk as well.

There are three reasons I believe the findings from this trial are true:

  • Studies that involve 116,000 patients are powerful.
  • This trial is consistent with the findings of many previous trials which also suggest that NSAIDs are bad for the heart.  We call this confirmatory evidence.
  • Clinical experience: One of the best ways to control blood-pressure–in a hard-to-control patient–is to stop their arthritis drug,  This move works like magic.  If taking away a substance something away improves a problem,  that substance wasn’t likely very safe.

Here’s the bottom line:

Like a ‘little’ wine with dinner, or an ‘occasional’ chocolate bar, small doses of NSAIDs taken over short durations (a day or two) are probably not harmful.

These drugs should not be used in the long-term.  They are dangerous–ask any gastrointestinal doctor, or kidney doctor.

“But Doc, they relieve my pain so well.”

Yes, for the millions with chronic muscular and skeletal pain, this is a huge problem for which I don’t have an answer.

For athletes, the solution is easier: when your body hurts, rest it. And then learn what causes the problem and avoid it. We call this prevention.

JMM

Comments

  1. says

    I read the article, but it’s mostly over my head. I get the gist that NSAIDS are bad. But what if NSAIDS are what allow you to do stuff (like ride & hike) and keep the deforming effects of arthritis at bay? How does a civilian evaluate risk/reward here?

    • says

      Allison,

      I think the chronic, daily use of these meds is a bad idea. But not everybody has problem with them. And I second your notion that not exercising is a terrible solution. My guess is that industrious motivated people can find a way to exercise without the

        longterm

      use of arthritis drugs.

  2. Sherri says

    So many people take these that this is a huge concern. I have friends that take 3 or 4 inbuprofen at a time. Before I quit smoking and started riding a bike I was taking an Aleve 3 or 4 times a week. I have taken fewer than 20 in 3 years. Recently my hands started bothering me, I think it’s arthritis. Trying to find a herbal remedy first. But at times one Aleve will do wonders for days.

    There is no free pass. A pill will not fix it all. Thanks for informing us Dr. John