Superb Health

Pain killers or bringers of pain?

 October, 2009

Prepared by: Dr. Shane J. Lynch, D.C.

Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999; (340) 24: 1888-1899.

A Nonsteroidal anti-inflammatory drug (NSAID) is generically known as Ibuprofen and is also packaged under such brand names as Advil, Bayer, Motrin and Midol. NSAIDs are available over the counter (OTC) and by prescription for such conditions as rheumatoid arthritis, osteoarthritis, mild to moderate pain, sunburn, menstrual pain and fever.1 The anti-inflammatory effects of NSAIDs are not usually seen in OTC dosages and require up to a week to appear at dosages >400 mg.1 Potential side effects include diarrhea, nausea, vomiting, constipation, upset stomach, stomach ulcers and gastrointestinal bleeding.

The topic of this article involves gastrointestinal complications occurring with long-term use of NSAIDs. Commonly these complications occur in prescription dosages (400mg/dose), but complications can just as easily occur with taking OTC dosages (~200-400mg) multiple times per day for extended periods of time. Individuals receiving long-term prescription dosages of NSAIDs often have a disabling condition and usually are prescribed additional medications to help combat associated side effects with NSAID use. Consumers of OTC NSAIDs should only use these products in extenuating circumstances; not as a daily preventive against minor aches and pain. All of us have some aches and pain at some point in our lives, but if you have such discomforts on a daily basis you need to objectively examine your lifestyle (i.e. diet, activity, attitude, etc. ) and make changes were needed. Pain serves as a gauge to let us know when things are not right with our body and to simply take an OTC pain medication on a daily basis without making lifestyle modifications does your body a serious disservice.
Key points:
“(NSAIDs) constitute one of the most widely used classes of drugs, with more than 70 million prescriptions and more than 30 billion over-the-counter tablets sold annually in the United States.”

“Although NSAIDs are generally well tolerated, adverse gastrointestinal events occur in a small but important percentage of patients, resulting in substantial morbidity and mortality.”

“In general at least 10 to 20 percent of patients have dyspepsia (indigestion) while taking an NSAID, although the prevalence may range from 5 to 50 percent.”

“…13 of every 1000 patients with rheumatoid arthritis who take NSAIDs for one year have a serious gastrointestinal complication.”

“It has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States. This figure is similar to the number of deaths from the acquired immunodeficiency syndrome (AIDS) and considerably greater than the number of deaths from multiple myeloma, asthma, cervical cancer, or Hodgkin’s disease.”

“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States.”

“…these toxic effects remain largely a “silent epidemic”, with many physicians and most patients unaware of the magnitude of the problem.”
“Only a minority of patients who have serious gastrointestinal complications report any antecedent (prior) dyspepsia.”

Risk factors for development on NSAID-associated gastrointestinal ulcers:

Advanced age, history of ulcer, concomitant use of corticosteroids, higher doses of NSAIDs, including the use of more than one NSAID, concomitant use of anticoagulants and existence of other serious diseases.

Mechanism of injury with NSAID use:

NSAIDs are highly acidic which directly irritates and damages the lining of the GI tract.

NSAIDs achieve their anti-inflammatory effects by inhibiting prostaglandins.

Prostaglandins, in addition to mediating the inflammatory response, also maintain the integrity/strength of the gastrointestinal mucosa (lining). “Prostaglandin inhibition, in turn, leads to decreases in epithelial (tissue) mucus, secretion of bicarbonate (pH buffer), mucosal blood flow, epithelial proliferation (growth), and mucosal resistance to injury”.

Other important functions of prostaglandins that are potentially inhibited by NSAID use includes: platelet aggregation, renal (kidney) function, mitogenesis and growth, regulation of female reproduction and bone formation.

Conclusions

Some individuals have serious systemic diseases that require long term use of NSAIDs in prescription doses (400mg/dose). These individuals also take a variety of medications to help curb side effects caused by long term NSAID use.
Over the counter NSAID use must be done so sparingly and should not be part of one’s daily health/preventive regime. Instead, try daily supplementation of cod liver oil which has a high percentage of omega 3 fatty acids which are the anti-inflammatory fatty acids. Vitamin-D is also an excellent supplement to take on a daily basis to help decrease the onset of generalized aches and pains. Chiropractic adjustments and daily activity, even short walks and light stretching, can help maintain the integrity of the musculoskeletal system preventing tight muscles and limited mobility.

Reference
Silverman HM. The Pill Book. New York: Bantam Books; 2002: 529-533. "Pain serves as a gauge to let us know when things are not right with our body," therefore fix the problem so you do not live life in pain. 

 "All of us have some aches and pain at some point in our lives, but if you have such discomforts on a daily basis you need to objectively examine your lifestyle."