Ask Dr. Scott: Daily use of common pain medication. Good or bad?

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Q: Dr. Scott, my mother uses an anti-inflammatory every day for pain. Is there a risk to her health in doing this?

A: Your mom is not alone — she makes up a part of the approximately 60 million Americans who use non-steroidal anti-inflammatory drugs (NSAIDs) regularly. A recent study in the American Journal of Gastroenterology by Lanas et al. (Lanas et al, 2012) on aspirin and NSAIDs reveals shocking mortality rates. In the United States there are 10,000–20,000 fatalities and multiple organ systems adversely affected by NSAIDs reported every year according to the World Journal of Gastroenterology. (Kim et al., 2016)

Another shocking fact is that every 19 minutes, someone in the United States dies from an unintentional prescription drug overdose. (American Public Health Association, 2017) Chronic pain is the primary reason for the use of these medications, and no other disease can make that claim. A strong painkiller paracetamol ibuprofen can be taken for intense pain but in limited amounts.  Older patients who have hypertension and coronary artery disease and who also use nonsteroidal anti-inflammatory drugs (NSAIDs) chronically for pain are at significantly increased risk of cardiovascular events according to research published in the American Journal of Medicine. (Bavry et al, 2011)

Dr. Bavry, lead author of this study said, “We found significant increase in adverse cardiovascular outcomes, primarily driven by an increase in cardiovascular mortality. This is not the first study to show there is potential harm with these agents, but I think it further solidifies that concern.” Dr. Bavry said the observational study was particularly relevant to everyday practice because the patients included were typical of those seen in internal-medicine, geriatric, and cardiology clinics — they were older, with hypertension and clinically stable cardiovascular disease. Bavry and colleagues were not able to differentiate between NSAIDs in the study — most people were taking ibuprofen, naproxen, or celecoxib — and said that until further work is done, he considers the risks of NSAIDs “a class effect”, and their use should be avoided whenever possible.

Fundamentally, it is the lack of access to other pain treatments that is the primary reason for NSAID over-prescribing. We have evidence-based treatments for pain — mostly ‘low-tech, high-touch treatments — that most people with chronic pain either do not know about or cannot access. Chronic back pain and its medical misdiagnosis and mistreatment appear to be dragging down the US economy. And along with other forces, this may be driving millions of prime age workers out of the economy altogether.

Your mother is medicating herself (possibly with the advice and consent of her medical doctor) for chronic pain, which afflicts more Americans than diabetes, heart disease, stroke and cancer combined. (The American Academy of Pain Medicine, 2017) Not only a huge social cost to our society in terms of disability, addiction and deaths, but the annual national economic cost associated with chronic pain is estimated by the Institute of Medicine to be $600 billion (an amount equal to about $2,000 for everyone living in the United States).

When I see patients like these taking NSAIDs, I have an informed discussion with them that if  a patient with chronic pain and inflammation is to improve, we must redraw their picture of chronic pain and NSAID use with a new but complete set of dots different.

One big clue missed by our media in this epidemic of chronic pain is the fact that back pain is the leading reason for the use of NSAIDs and prescription painkillers. (Boudreau et al., 2009) Mark Schoene, the 25-year editor of an international spine research journal, The BackLetter, wrote of this mess:

“There is an urgent need to restrain the routine prescription of opioids and NSAIDs for common non-cancer pain conditions — and especially chronic low back pain. There is no evidence that they are an effective long-term treatment. And their risks are obvious.” (BackLetter, 2016)

These medical interventions fail to address the cause of the pain: they treat only the symptoms — an approach that lessens pain for a limited period of time.

I suspect that the popularity of complementary and alternative medicine is a coded message about aspirations for more acceptable or more effective health care throughout the developed world. This is also what health care reform in the United States intends to achieve. Yet if “modernization” allows the voices of poorly met needs to be heard, it will surely take more than high-tech medicine (drugs, shots, surgeries, hospitals) to satisfy them. Therefore, if too few chiropractors, nurses, physiotherapists, health educators, counselors, osteopaths, nutritionists, naturopaths, acupuncturists and massage practitioners are working in primary care in the United States today who provide the recommended treatment methods for chronic pain, then it may be a measure of how little holistic care is actually being delivered in this country…for your mother and the rest of us.

Dr. Scott Cuthbert is the chief clinician at the Chiropractic Health Center in Pueblo, Colorado, as well as the author of two new textbooks and over 50 peer-reviewed research articles. 

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