Pain. What comes to mind when you hear that word? The opioid crisis? After all, pharma companies flooded the U.S. with 76 billion oxycodone and hydrocodone pain pills from 2006 through 2012.
Or maybe you think of over-the-counter pain relief from ibuprofen, naproxen or aspirin? More than 29 billion of such OTC nonsteroidal anti-inflammatories, NSAIDs, are sold annually in the U.S.
Or maybe you just think "OUCH."
Around 50 million Americans contend with chronic pain, defined as pain on most days or every day in the past six months. Almost 20 million deal with what's called high-impact pain, meaning it interferes with work, their social and recreational life and self-care.
But you may never have thought about the fact that both OTC and prescription NSAIDs are associated with approximately 100,000 hospitalizations and 17,000 deaths in the U.S. every year.
So let's look at how you and your doctor can decide if the benefits - there are many, from pain relief to improved cognition and better quality of life - outweigh the side effects (also a bunch) for you.
Cardiovascular and Gastrointestinal Risks: Aspirin is a NSAID that reduces inflammation, eases pain and is cancer- and heart-protective. But unfortunately, it also carries the risk of gastrointestinal bleeding and peptic ulcers.
Nonaspirin NSAIDs, such as ibuprofen and naproxen, decrease inflammation, easing pain associated with arthritis, injury, headaches, surgery and sprains. But cardiovascular complications include congestive heart failure; heart attack; stroke and thrombosis. Overall, nonaspirin NSAIDs raise blood pressure, and if you are taking an antihypertensive, a nonaspirin NSAID may make it less effective. Plus:
- With long-term and/or high-dose use, one study in The Lancet found that heart failure risk was roughly doubled by all NSAIDs. It also found that ibuprofen (but not naproxen) significantly increased major coronary events such as heart attack and stroke.
- A Danish study of 29,000 people published in the European Heart Journal, found ibuprofen (not naproxen) upped the risk of cardiac arrest by 31% in folks who had taken it in the past 30 days.
- Gastrointestinal complications are most likely when higher doses are taken by folks 65 or older and in anyone with a history of peptic ulcer, heart disease, or who is taking an antiplatelet medication, corticosteroids or anticoagulants.
- If you're a chronic user of nonaspirin NSAIDs and have none of those risk factors, your chances of a serious adverse gastrointestinal reaction are only 0.4%. With multiple risk factors it jumps to 9%. And overall, ibuprofen has a lower relative risk of gastro problems than naproxen.
- If you're taking low-dose aspirin for your heart, the risk of gastro problems depends if you have those risk factors or not. If you do, you may need to take a PPI to prevent adverse effects. Ask your doc. Always take a half of glass of warm water before and after every aspirin. (A good idea with nonaspirin NSAIDs too!)
As you can see, it's a bit complicated to figure out which NSAID to take and if the risks are worth the benefits. According to a new study, the smartest way to deal with the challenge is look at your benefits from taking an OTC NSAID. Balance that against your health profile, especially if you have any of the risk factors for complications. Then talk to your doc to determine what's the safest and most effective for you. Also:
- Don't take these over-the-counter NSAIDs for many days in a row without a doctor's OK.
- If you do take them, aim for the lowest effective dose for the shortest length of time.
- Do not take more than one kind of NSAID at a time.
- And remember that drink of water.
To help manage pain, also try using patches or ointments for pain in a specific area; physical therapy; DHA omega-3s; and mindful meditation and cognitive behavioral therapy to alter your response to pain. Pain causes stress, and stress causes more pain.
Distributed by King Features Syndicate, Inc.
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