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NSAIDs, Anti-Inflammatories, Pain Medications

Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases
This page was written by Janey Willis. See Disclaimer.
Overview of NSAIDs
FDA Warnings
NSAIDS and Cancer
Possible Side Effects Cox-2 Inhibitors

Overview of NSAIDs

Interestingly, opiates — like codeine or morphine — are much safer for long term use than NSAIDs for the elderly, or for people with chronic illness.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve pain.

Even though they are available over-the-counter, that does not mean that they are harmless, nor that they should be taken for more than a brief period (as stated on the label) without consulting a doctor.

Often there are safer or more effective alternatives, and sometimes their use masks issues that need more medical attention.

Side effects of NSAIDs can include increased risk of asthma, dementia, and internal bleeding. Except for aspirin, NSAIDs also increase the risk of heart attack, stroke, and heart failure.

Experts advise that the elderly and people with chronic illnesses should first try acetomenophen, but to never take more than the safe amount listed on the container, because even slight overdoses can cause liver failure and death.

If NSAIDs do not work, then opiates (like codeine or morphine) are much safer for long term use. (Also see: What is Scleroderma?, Medical Overview, and Medications for Scleroderma, Arthritis, Autoimmune and Rheumatic Diseases)

Information for Patients About NSAIDs. Traditional NSAIDs include aspirin, ibuprofen (e.g., Advil, Motrin), naproxen (e.g., Aleve) and many other generic and brand name drugs. A newer addition to the NSAID group is celecoxib (Celebrex) which is a COX 2 Selective NSAID. American College of Rheumatology.
Nonsteroidal anti-inflammatory drugs (NSAIDs). Non Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications which, as well as having pain-relieving (analgesic) effects, have the effect of reducing inflammation when used over a period of time. MedInfo.co.uk.
Taking more than one painkiller risky: study. People who use two or more non-steroidal anti-inflammatory drugs (NSAIDs) to help control pain have a worse health-related quality of life than their peers who use only one, results of a study suggest. Reuters. 02/11/08.
Scleroderma Treatments and Clinical Trials ISN.

Possible Side Effects of NSAIDs

NSAIDs. Dosage,Side Effects, Drug Interactions, Warnings. About.com.
Anti-inflammatory drugs don't cut dementia risk, they raise it. Researchers followed 2,736 members of Group Health who were an average age of 75 at the study's start. Participants were tracked for 12 years to see if they developed dementia, including Alzheimer's disease. Mary Brophy Marcus, USA TODAY. 04/22/09.
Acetaminophen use and the risk of asthma in children and adults: a systematic review and metaanalysis. The results of our review are consistent with an increase in the risk of asthma and wheezing in both children and adults exposed to acetaminophen. Future studies are needed to confirm these results. Chest. 2009 Nov;136(5):1316-23. (Also see: Asthma)
Use of NSAIDs and infection with Helicobacter pylori-what does the rheumatologist need to know? Ulcer risk reduction after H. pylori eradication therapy is clearly more marked in patients beginning NSAID therapy than in patients who were already receiving and tolerating NSAID therapy. U. Kiltz. Rheumatology Advance Access. May 13, 2008 (Also see: GI Involvement).
American Heart Association statement recommends doctors change approach. Many doctors should change the way they prescribe pain relievers for chronic pain in patients with or at risk for heart disease based on accumulated evidence that nonsteroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, increase risk for heart attack and stroke. EurekAlert! 02/26/07. (Also see: Cardiac Involvement)

FDA and Other Warnings about NSAIDs

Study: Taking Just a Little Too Much Tylenol Each Time Can Be Deadly. Taking just a little bit too much acetaminophen (Tylenol) over the course of days or weeks is more likely to be fatal than taking a single, massive overdose, according to a new study. Time HealthLand. 11/23/2011.
The Danger of Daily Aspirin. Medical experts say some people who are taking aspirin on a regular basis should think about stopping. The concern is that aspirin's side effects, which can include bleeding ulcers, might outweigh the potential benefits when taken by many healthy or older people. Anna Wilde Mathews. Wall Street Journal. 02/23/10.
Experts Warn Against Long-Term Use of Common Pain Pills. An expert panel of the American Geriatric Society has removed almost all non-steroidal anti-inflammatory drugs (NSAIDs) from the list of recommended medicines for older adults with chronic, persistent pain. According to this panel, long-term use of NSAIDs such as ibuprofen, naproxen, and high-dose aspirin is so dangerous that it would be safer for elderly people to take opiates such as codeine or morphine for pain relief, if they can't get relief from acetaminophen. Roni Caryn Rabin. The New York Times. 05/06/09. (Also see: Managing Pain)

NSAIDs and Cancer

Use of non-steroidal anti-inflammatory drugs and prostate cancer risk: a population-based nested case-control study. Our findings suggest modest benefits of at least some NSAIDs in reducing prostate cancer risk. Mahmud SM. PLoS One, 2011 Jan 28;6(1):e16412.
Aspirin, ibuprofen may cut breast cancer risk. In the past, researchers have flip-flopped on the issue, so they recently combined some of the best data - from 2.7 million women in 38 separate studies - to look for solid evidence. And they found it. Women who took aspirin had a 13 percent lower risk of breast cancer than those who didn't, while those who took ibuprofen had a 21 percent lower risk. Theresa Tamkins. CNN Health. 10/08/08. (Also see: Cancer)

Cox-2 Inhibitors

COX-2 inhibitors are a form of non-steroidal anti-inflammatory drug (NSAID) that directly targets COX-2, an enzyme responsible for inflammation and pain. Celebrex and Vioxx are Cox-2 inhibitors.
Cox-2 Inhibitors. The COX-2 inhibitors represent a new class of drugs that do not affect COX-1, but selectively block only COX-2. This selective action provides the benefits of reducing inflammation without irritating the stomach. MedicineNet.com.
Cox-2 Use Is Down, but Ulcers Are Up. Patients turn to traditional NSAID painkillers but skip drugs that protect their stomachs. WebMD. 11/10/07.
Arthritis Drug Vioxx Recalled. Merck & Co. is pulling its blockbuster arthritis drug Vioxx from the market worldwide because new data from a clinical trial found an increased risk of heart attack and stroke. CBS News 09/30/04. (Also see: Medications)
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