Archive for NSAIDs dangerous
This is certainly not the first time I’ve written about the hazards of using anti-inflammatories at the first sign of a twinge. But this one is going to take it from a different viewpoint.
I think we could all agree that the process of inflammation is a natural one. After all, why would the human physiology have a process in place that is useless? It wouldn’t. Inflammation serves several purposes. One key purpose would be the prevention and management of infections. Your immune system (the system responsible for the inflammatory response) gears up to fight off an invader, and, should that invader break through, it will gear up an attack on that invader, be it a virus, bacteria, yeast or even a tumor cell. Another key purpose is the clearing out of damaged tissue and subsequent repair of the damaged region.
Each of these actions of the immune system needs balance and control:
- Too much protection against an invader and you get allergies and asthma.
- Too strong of a reaction against an invader and you could go into shock.
- Too strong of a response to an injury and undamaged tissue gets taken out in the process.
But these are all on the upswing of the inflammatory response and controlling this side of things is a good thing. But can our society’s obsession with anti-inflammatories be affecting the natural history of this process? You bet!
Consider inflammation as pushing a boulder uphill. Once you get it over the top, the going’s easy from there. Anti-inflammatories may, in the initial stages, make the hill smaller. But the initial stages of inflammation are supposed to end–after a few days with an infection (hopefully) and within 24 hours with an injury (depending on severity of the injury). We used to think that inflammation, once started, would resolve all on its own. We now know this is not true.
The resolution of inflammation is not a passive process. The body has to actively end inflammation. And there are some critical factors needed for this process.
Namely, our old friends, DHA and EPA from fish oils.
Specifically, DHA and EPA are required to make a class of compounds referred to as Resolvins and Protectins (I know, but I didn’t come up with the creative names…). If you’re a biochemistry nerd, you can read more about them in this particular review.
This begins to explain the many benefits we see from essential fatty acid supplementation on a long list of chronic disease. More importantly, you can begin to lay out some “to do” things on your journey to control and resolve inflammation in your own body. These include:
- Increasing your intake of healthy fats found in such foods as wild caught fish, olive oils, raw nuts, seeds and avocados.
- Decreasing your intake of less healthy fats found in hydrogenated oils and vegetable oils.
- Avoiding anti-inflammatories. With the exception of aspirin, which may help the process, other anti-inflammatories actually slowed or stopped the ability of EPA and DHA to halt inflammation.
- If inflammation from an autioimmune disorder or chronic pain is a concern, consider supplementing UP TO 3 full grams of omega-3 / day (this does NOT mean 3 capsules per day).
So, next time you think about curbing inflammation with drugs, shift your thinking. Think about how you are going to RESOLVE your inflammation instead.
Risk of birth defects and miscarriage in pregnant users of NSAIDs
This study did not show an increase risk of birth defects w/ NSAID use, but did show an increase in the likelihood of a miscarriage. In many women unable to maintain a pregnancy, factors such as this, as well as homocysteine levels should be checked to increase the chance of a full term delivery.
bmj.com Abstracts: Nielsen et al. 322 (7281): 266
NSAIDs and Persistent Pulmonary Hypertension of the Newborn
This article points out yet another side effect of NSAIDs; potentially damaging effects on the fetus. It never ceases to amaze me that so many patients consider chiropractic dangerous and yet can not put NSAID use into perspective. This effect on the fetus is new to me, but does not surprise me. Add it to the list of kidney, liver, articular and GI damage.
Pediatrics — Abstracts: Alano et al. 107 (3): 519
Direct toxicity of NSAIDS for renal medullary cells
Much attention has been focused on the gastrointestinal side effects of NSAIDs, but frequently the damaging effects on the liver, kidneys and joints are never mentioned. An article that appeared in the NEJM several years back gave a LIFETIME accumulation of effects from NSAIDs and acetominophen. 5000 NSAIDs over a lifetime increased risk of renal failure by several fold. How many of us hit this by the time we’re 20?
PNAS — Abstracts: Rocha et al. 98 (9): 5317
Anti-Inflammatory Treatment of Soft-Tissue Sports Injuries
This article is a review of standard pharmaceutical approaches to chronic and acute sports injuries. As many of us in the manual medicine side of things have known forever, this author suggests that the benefits of anti-inflammatories is very limited and maybe even harmful.
(article) Treatment with anti-inflammatory medication is a popular choice of athletes and healthcare professionals. The effects of NSAIDs on the inflammatory reaction following an acute soft-tissue injury are small and do not appear to change the natural history of these injuries to any great extent. Derived from the hormone cortisol, corticosteroids are associated with much more pronounced and lasting anti-inflammatory effects compared with NSAIDs. Numerous studies have shown that they, in fact, can halt the healing process by virtually eliminating the inflammatory response. Inferior healing of ligament sprains and muscle strains has been observed in several animal models. For this reason, most healthcare professionals believe that corticosteroids have no role in the treatment of acute soft-tissue injuries.
Treatment of chronic problems is traditionally through relative rest, physical therapy, and NSAIDs. Again, NSAID use can result in pain relief but does not appear to promote healing of these conditions. Several randomized studies have failed to show a significant advantage over other analgesics or even placebo. Other treatment modalities may be more important to stimulate healing in these conditions. Corticosteroids also remain a popular choice in the treatment of chronic soft-tissue injuries. Often they are used in a parenteral form and injected directly on and around the affected tendon. A corticosteroid injection can result in quick and dramatic relief of the pain symptoms associated with tendinopathy. The exact mechanism through which this is accomplished remains unclear, as inflammatory features are often absent in these lesions. Problems associated with corticosteroid use include weakening of the tendon and the possibility of tendon rupture. Although the exact rupture risk has not been determined, many healthcare professionals avoid using corticosteroids in weight-bearing tendons such as the Achilles tendon. In the upper extremity, corticosteroids are more frequently used. In addition, the pain relief obtained from a corticosteroid injection can be temporary. Recurrence of the pain after several weeks is not uncommon.
This is one of the best ways to combine the best of nutrition w/ the best of Western medicine. But don’t hold your breath waiting for it to become standard prescription practice.
Investigational studies of a formulation of extended release niacin and lovastatin show that the combination is safe and well-tolerated and that it improves a number of lipid profile markers. Dr. Moti L. Kashyap of Long Beach Veterans Administration Medical Center, in California, presented findings from a study of combination therapy in 814 patients in a dose-escalating open-label study during the 49th scientific sessions of the American College of Cardiology. Dosages ranged from niacin 500 mg + lovastatin 10 mg to niacin 2,000 mg + lovastatin 40 mg. Dr. Kashyap said that the combination drug, Nicostatin (Kos Pharmaceuticals, Miami Lakes, Florida), has additive effects over monotherapy with either of the two drugs alone, especially in lowering LDL cholesterol, raising HDL cholesterol and lowering triglycerides.
Whoa!! Very important news. We all know that NSAIDs (ibuprofin and it’s kin…) have damaging side effects on the stomach, liver, joints and kidneys. But increasing your risk of congestive heart failure? If a natural remedy had even 1/10th of the dangers of NSAIDs, it would be yanked off the market faster than you could say “Celebrex”. Remember the tryptophan contamination way back when? A handful of deaths were attributed to a contaminant in the supplement (not the supplement itself) and it was yanked off the shelves and still can’t be sold; yet, an estimated 15,000 people die from NSAIDs per year!!!
More benefits of monounsaturated fats…
NICE Says COX-2 Inhibitors Should Be Reserved for High-Risk Patients
Gosh, I’ll but Pharmacia and Merck weren’t terribly happy about this announcement!! Overall, despite much, much hype, the evidence supporting greatly safety with the new selective COX-2 inhibitors for pain is just not that strong. Remember that most NSAIDs inhibit both cyclooxygenase 1 and 2 and that COX-1 has a protective effect on many tissues in the body and that COX-2 is needed for certain pain producing pathways. Block COX-1 and you block the body’s ability to protect itself and create injury. However, we still do not fully understand the picture of what COX-2 does. Block it and we are not yet sure what the long term consequences may be. The arrogance of man over nature never ceases to amaze me. Remember that nature already makes some selective COX-2 inhibitors with centuries of safety.
(article) Britain’s National Institute for Clinical Excellence (NICE) said on Thursday that Merck and Pharmacia’s blockbuster cyclooxygenase 2 inhibitors, Vioxx (rofecoxib) and Celebrex (celecoxib), should not be used routinely. In guidance to the National Health Service, NICE said that selective inhibitors of COX-2 should be used instead of standard nonsteroid anti-inflammatory drugs (NSAIDs) only by people with rheumatoid arthritis or osteoarthritis who are at high risk of developing serious gastrointestinal adverse events. NICE defined high-risk patients to include those over 65 years, those already using medications known to increase the likelihood of upper gastrointestinal adverse events, those with serious co-morbidity, and those requiring prolonged use of maximum recommended doses of standard NSAIDs. NICE also announced that its appeals’ committee has rejected all appeals by Pharmacia and Merck. Both companies had complained that the Institute’s guidance was perverse in the light of the evidence submitted. The guidance says that all NSAIDs, including the COX-2 selective agents, can cause gastrointestinal adverse events, including life-threatening perforations, ulcers or bleeds. “The risk of NSAID-induced complications is particularly increased in patients with a previous clinical history of gastroduodenal ulcer, gastrointestinal bleeding or gastroduodenal perforation. The use of even a COX-2 selective agent should therefore be considered especially carefully in this situation.” The guidance adds that concerns have been raised over the cardiovascular effects of COX-2 drugs. One study comparing Vioxx and naproxen detected an increase in the rate of myocardial infarction in the Vioxx group. Further research is needed to resolve this issue but in the meantime the potential increased risk should be taken into account when prescribing COX-2 agents for patients with cardiovascular disease, according to the guidance.
A Cyclooxygenase-2 Inhibitor Impairs Ligament Healing in the Rat
Just in case you thought you’d skip the old fashioned NSAIDs and go for the fancy new selective COX-2 inhibitors, better hope there’s no soft tissue damage. Use of anti-inflammatories for virtually all injuries is just short of legendary, and yet we never give a second’s thought to whether they might actually inhibit the healing process. Well…evidence does seem to lean towards weakening of healed ligaments with NSAID use. My advice…ice it down and see your local chiropractic who uses soft-tissue therapies…
AJSM — Abstracts: Elder et al. 29 (6): 801
NSAIDs, First Occurrence of Heart Failure and Relapsing Heart Failure
I was not aware that NSAIDs will increase risk of recurrent attacks of heart failure, but it appears that this risk is quite substantial. This definitely fits the mold of the new selective COX-2 inhibitors increase risk of heart failure. Remember that we do not fully understand the physiology of most processes in the human body, and blocking one pathway artificially will inevitably produce downstream effects (usually harmful) due to the blocked pathway.
Analgesic use: Predictor of chronic pain, medication overuse headache
The results of this study find that in patients with heavy analgesic use, they were more likely to experience chronic pain 11 years later. This is not really a big surprise since it is well known that NSAIDs inhibit proper healing of connective tissue. Consider a patient on long term NSAIDs that sustains an injury. The injury never properly heals because of the block to normal healing. We know have a tissue that is prone to injury, setting up the cycle for further injury and NSAID use.
Neurology — Abstracts: Zwart et al. 61 (2): 160