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To provide guidance to health care providers and their patients in their clinical decision-making, researchers from Florida Atlantic University's Schmidt College of Medicine have published a review in the Journal of Cardiovascular Pharmacology and Therapeutics addressing cardiovascular risks and beyond, which include gastrointestinal and kidney side effects of pain relievers. They examined the benefits and risks of over-the-counter and prescription drugs for pain relief such as aspirin, ibuprofen (Motrin or Advil), naproxen (Aleve), and prescription drugs such as diclofenac (Voltaren), a non-aspirin NSAID [Non-Steroidal Anti-Inflammatory Drugs], and selective cyclooxygenase-2 inhibitors such as celecoxib (Celebrex) as well as acetaminophen (Tylenol).
NSAIDs include aspirin, traditional non-aspirin NSAIDs such as ibuprofen, (Motrin or Advil), naproxen, (Aleve) and diclofenac, (Voltaren) as well as selective cyclooxygenase 2 inhibitors (COXIBs), such as celecoxib (Celebrex), and acetaminophen (Tylenol).
All of these drugs have benefits and risks. Aspirin decreases inflammation as well as coronary events and stroke, but increases gastrointestinal symptoms and bleeding, however, without adverse hepatic or renal consequences. Non-aspirin NSAIDs decrease inflammation, but have been associated with adverse major coronary events and stroke with long-term use as well as major upper gastrointestinal and kidney side effects, as well as electrolyte imbalances such as high sodium or potassium and even heart failure.
Cyclooxygenase 2 (COX2) inhibitors were developed primarily because of their more favorable gastrointestinal side effect profile relative to aspirin and traditional non-aspirin NSAIDs, but confer adverse cardiovascular as well as hepatic and renal effects. Acetaminophen has no clinically relevant anti-inflammatory properties and accounts for more than 50 percent of drug overdose related liver failure and about 20 percent of liver transplant cases, as well as kidney disease.
[...] "The factors in the decision of whether and, if so, which drug to prescribe for relief of pain and inflammation, should not be limited to risks of cardiovascular or gastrointestinal side effects. These considerations should also include potential benefits including improvements in overall quality of life resulting from decrease in pain or impairment from musculoskeletal pain syndromes," said Charles H. Hennekens, M.D., Dr.P.H., corresponding author, first Sir Richard Doll Professor and senior academic advisor in FAU's Schmidt College of Medicine.
Journal Reference:
Manas A. Rane, Alexander Gitin, Benjamin Fiedler, Lawrence Fiedler, Charles H. Hennekens. Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs$. Journal of Cardiovascular Pharmacology and Therapeutics, 2019; 25 (1): 3 DOI: 10.1177/1074248419871902
(Score: 4, Interesting) by Anonymous Coward on Tuesday February 11 2020, @09:58PM (3 children)
No thanks, you say...
'Acetaminophen has no clinically relevant anti-inflammatory properties and accounts for more than 50 percent of drug overdose related liver failure and about 20 percent of liver transplant cases, as well as kidney disease.'
This side of the pond, we know Acetaminophen more by the name Paracetamol, which my sister takes a rather large amount of on a daily basis as part of her Rheumatoid Arthritis drug regime. She was told it was an anti-inflammatory, and she has said from the start that 'it doesn't fucking work', not even as an analgesic either alone or combined with codeine. So, this little snippet was news to me, and one quick trawl through some medical papers and it's apparently true about the lack of efficacy. I can see there's a bit of further trawling involved before the next meeting with her quacks.
So, let's not call it dishing out medical advice, let's call it dishing out pointers..
As to the subject of TFA, speaking from personal experience, as painkillers, Acetaminophen/Paracetamol has never worked for me, ditto re Ibuprofen. The old standby Aspirin works, to a point, opiates obviously work...but they're just that wee bit too 'moreish', however I've found that whisky¹ works a lot better (which is why I keep a bottle of the cheap stuff handy - currently a bottle of Dimple Golden Selection, no point wasting single malts...) , and absinthe, ouzo (not the cheap watered down tourist shit) or B.P. grade Ethanol work best..
--
¹ Whisky, in my case, seems to work better as an analgesic than, for example, Rum, however YMMV... I'm quite willing to volunteer for a proper medical study into the relative analgesic effects of a range of spirits on my wrecked and tortured body, science needs to know things like which malt whisky blend is best for toothache!..
However, having shared a flat with medical students (who are all now Doctors) and having been to many parties with their good selves and Nurses, I fear that any supplies bought in for such a study would be joyously quaffed by those of the medical professions involved in said study long before I'd get to see them..tosspots(trad) the lot of them...
(Score: 2) by Azuma Hazuki on Wednesday February 12 2020, @03:14AM
APAP doesn't have somatic anti-inflammatory effects, this is true. It acts centrally, and apparently one of its metabolites looks a lot like anandamide, an endogenous *cannabinoid.* From personal experience, I can tell you 500-1,000mg of APAP does seem to take the edge off, but it's something I try to take no more than a few times a month.
I am "that girl" your mother warned you about...
(Score: 2) by RS3 on Wednesday February 12 2020, @03:07PM
Acetaminophen compliments aspirin, ibuprofen, naproxen sodium, and others. "Excedrin" is aspirin, acetaminophen, and caffeine. When combined, most people get twice the pain relief of the same amount of either.
Mixing NSAIDs is strongly discouraged, but any can be taken with acetaminophen (unless the person has some rare reaction to the mixture).
Has your sister tried meloxicam?
(Score: 1, Informative) by Anonymous Coward on Wednesday February 12 2020, @04:07PM
You are correct that acetaminophen is not anti-inflammatory. It it thought to work by addressing nociceptive pain receptors directly and may dull the pain response to them. It can work and does better for aches and pains caused by physics causes (i.e. cuts, bruises, bumps).
Ibuprofen *is* an NSAID and can work with certain types of inflammation.
Opiates generally work by influencing mu nerve receptors in the nerve-to-nerve transmission of pain (it dulls the signal in tranmission, not at the received site source).
Alcohol works by keeping your brain from noticing the pain and has nothing to do with the extra-cerebral nervous system at all. It's not a pain killer, it's a CNS depressant. Ativan and other benzos do something similar with neurotransmitters - doesn't kill pain but rather makes you not care about it or keeps you from noticing it. Caffeine works by keeping your body from falling into stimulant withdrawl, and as a stimulant seems to work well for some migraine sufferers where the migraine may be rolling in due to a chemical domino effect.
What the article is saying is what professionals have known for a long time: Different types of pain relievers and adjuvant medications for different kinds of pain.