New Research Dividing Physicians Over NSAIDs For Chronic Pain

NSAIDsWhen you suffer an injury, it causes an inflammatory reaction inside the body, and if the problem isn’t treated correctly, this inflammation can linger. The prevailing understanding when it comes to chronic pain is that it is caused by chronic inflammation, which is why many specialists try to prevent the problem by working to control inflammation. Anti-inflammatory medication like Ibuprofen has been a common recommendation for decades as a way to effectively manage inflammation and work to reduce the risk of it becoming chronic.

However, new research seems to suggest that attempting to drown out this inflammation with anti-inflammatory medications before it gets out of control may not be providing the benefits we assume it does. In fact, they believe short-term use of these Non Steroidal Anti-Inflammatory Drugs (NSAIDs) may actually increase your risk of chronic pain in the long term, and that claim is dividing the medical world.

Ibuprofen And Chronic Pain

The new research suggests that the initial inflammation that develops after an injury may be necessary for the body to make a full recovery. If this suggestion is true, it could shatter the decades-old standard of treating pain with aspirin, ibuprofen or IV steroids at the hospital. By drowning out this necessary initial inflammation, researchers suggest NSAIDs may actually be putting patients at a greater risk for developing chronic pain.

“For many decades it’s been standard medical practice to treat pain with anti-inflammatory drugs. But we found that this short-term fix could lead to longer-term problems,” says Jeffrey Mogil, a Professor in the Department of Psychology at McGill University and E. P. Taylor Chair in Pain Studies. “Neutrophils dominate the early stages of inflammation and set the stage for repair of tissue damage. Inflammation occurs for a reason, and it looks like it’s dangerous to interfere with it.”

Now, it’s worth noting that not everyone agrees with the research, at least not without additional evidence. The paper was rejected from the New England Journal of Medicine after one reviewer wrote that he would not “overturn decades of medical practice,” until additional convincing evidence was presented.

Even if the findings are true, as we’ve said countless times on our blog in the past, it may only hold true for a subset of patients because chronic pain is so unique to the individual, and what works for one patient may not work for others. For example, the shock and inflammatory response of an ankle sprain and a surgery vary greatly, and assuming this research applies unilaterally to both of these groups could lead people down the wrong treatment path.

So while the jury is still out on whether or not NSAIDs may be having some unintended consequences for our ability to help pain resolve, the good news is more research is being poured into how to best handle chronic pain, and that’s a great thing. The more we learn, the better we can help each patient.

If you need help with a chronic pain issue, reach out to Dr. Cohn’s office today at (952) 738-4580.

NSAIDs For Inflammation And Pain Relief

NSAIDS pain pillsNonsteroidal anti-inflammatory drugs (NSAID) are the most commonly prescribed drugs in the world. Generally they are safe medications and they are often available as over-the-counter (OTC) items. The risks and benefits of these drugs are often misunderstood. Taking too much is common; not taking enough to be effective may also be an issue. The directions on how to take the drugs do vary depending on the exact compound. Furthermore, every drug has different strength, so a small amount of one drug could be stronger than a big pill of another one. Lastly, some drugs have unique delivery systems, such as they are available in creams to put on the skin.

Understanding NSAIDs

Medications like aspirin, ibuprofen, naproxen and diclofenac are the most common NSAIDs that are used and available OTC. Acetaminophen (Tylenol) is not a NSAID since it does not have any anti-inflammatory activity. NSAIDs inhibit cyclooxygenase (COX) enzymes, and these affect the making of certain prostaglandins and thromboxanes, leading to their anti-inflammatory abilities.

Inflammation is a cause of pain in many ailments, like osteoarthritis, rheumatoid arthritis, headaches, low back pain, and many causes of muscle and joint pain. Using a medication that blocks inflammation therefore often diminishes pain. If one has ongoing muscle or joint pain, these medications may be helpful. If your pain is due to nerve damage or irritation, like a disc bumping a nerve, or nerve trauma and damage, NSAIDs often do not help. Some of these NSAIDs come in crèmes, especially aspirin, and diclofenac, and using them on painful muscles and joints every four hours as needed can be extremely helpful with little or no risk overall to your health.

NSAID Risks

These medications have been thought to increase the risk of heart disease, especially the risk of a heart attack or stroke. Vioxx was an anti-inflammatory that was pulled from the market because it did increase the risk of heart attacks. Celebrex is very similar to Vioxx in how it works and there was concern it had some of the same risks related to heart attacks. Ibuprofen, aspirin, and naproxen are not as selective for just inflammation as Celebrex and have been found not to increase heart attack risk. In November 2016, a huge study reported that looked at the risk of Celebrex compared to the other NSAIDs and found the risk to be fractionally less. The overall risk for taking an NSAID is 0.7% for having a cardiovascular event. What this means is the risk for heart attacks while taking any of these medications is very low.  

The most important risks of this class of drugs are the affects on the stomach, kidney, and on hypertension. Nonsteroidal anti-inflammatory drugs as noted above affect prostaglandins and thromboxane, and these compounds in the body can affect bleeding and blood clots. Taking NSAIDs can irritate the stomach causing pain and bleeding, if this happens, the medications should be stopped and your doctor told about the symptoms. If one is taking a medication to thin blood to prevent a blood clot, an NSAID or aspirin can make one prone to bleeding problems and should also not be taken. The changes in prostaglandins caused by the NSAIDs can affect how well the kidneys work, as one gets older, the kidney function may naturally be diminished and these drugs can cause the kidneys to fail. The affect on the prostaglandins also impacts blood pressure in some people. If you have hypertension, these can make the problem worse and may need to be stopped or changed to a different NSAID. In general, these medications do not affect the liver and do not cause liver damage. There are other reactions to NSAIDs but these are less common, if they seem to be causing some sort of medical problem, talk to your doctor.