In the Prime Post up: The dangers of pain medicines — Part 1

I’m tiptoeing out on a limb.

In my state of Kentucky, few potatoes are hotter.

I started this In the Prime post fully intending to discuss the under-appreciated dangers of NSAIDs (Non-Steroidal-Anti-Inflammatory Drugs), like ibuprofen, naprosyn, and celecoxib (Celebrex).

Three things got me thinking about the thorny issue of treating pain.

First: More than one Kentucky doctor has told me of the unintended consequences of our state’s legislative action on opioids. Namely, that patients who have no business on NSAIDs are increasingly being put on them. And equally scary: patients in desperate need of pain control are having to hurdle high barriers to get access to appropriate medication.

Second: A surgeon recently asked me to explain why I didn’t want one of my patients with heart disease on a NSAID. He had never heard of the many potential harms of these drugs. Holy cow! I learned this stuff in the 1990s.

Third: Hardly a week goes by that I don’t see an NSAID-related problem. It might be a gastrointestinal bleed, exacerbation of high blood pressure or swelling in the lower extremities, to name just a few of many.

So it was that I started to write about these baddies. Here they are available to the public over the counter in any grocery. Patient safety advocates seem to gloss over them.

But then, I got to thinking about the alternatives to NSAIDs. What else can we do to relieve pain? Opioid drugs have serious downsides. The milky white steroid injected into joints was supposed to be safe too.

Here’s a quote that sums up the issue of pain control:

Despite breathtaking advances in the treatment of human disease, the control of pain is fraught with inefficacy and safety issues. Excluding palliative care and hospice specialists, who tend mercifully and skillfully to patients at the end of life, the truth is that the rest of the medical establishment struggles to control pain.

I can’t seem to free myself from thinking that the bottom line for pain control is the same as heart disease. Preventing the conditions that lead to chronic pain is better than trying to treat it after the fact. Surely we can’t stop cyclists from falling down, but you know that the same choices that reduce heart disease will also help our backs and necks.

Here is the link to the piece: The dangers of pain medicines — Part 1

JMM

4 comments

  1. I’ve always believed it is best to find the source of the problem with any health condition to avoid using medications which can always produce an unwanted side effect. I worry about medications I take for migraine’s. They are usually sinus related and I take decongestants and they too can raise blood pressure. Sometimes it seems like a no win situation choosing between 2 different types of medications that can cause other problems.

  2. Where do you stand on the issue of controlling the crippling and disfiguring aspects of osteoarthritis? My husband has it in his hands, three years ago his PCP put him on Celebrex and it stopped the progression and the pain in its tracks. I don’t know if he’s just lucky that he tolerates it so well, or if lifestyle mitigates the side effects. If people are in pain, they don’t work out. What is one to do?

  3. From the Rheumatologist: “Heart Meds Bad, Pain Meds/NSAIDs Good”

    From the Cardiologist: “Pain Meds Bad, Heart Meds Good”

    From the Opthamalogist: “NSAIDs Good, Heart Meds Bad”

    From the Gerontologist: “statins may be the root cause of Dementia”

    From The GP: “Everything Good”

    you can’t win

  4. John – Once again you are right on target. Clearly some patients benefit from NSAIDs (ie, Allison – though I don’t know that NSAIDs stop arthritis progression per se …. ) – but the risk of adverse effects to me far outweighs the benefits in many (most) patients for chronic longterm use (different for a short course of NSAIDs in a healthy person, for whom the drug may be wonderful). More NSAIDs is the not solution to addressing opioid abuse …. but as you indicate – this is what is happening …

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