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posted by janrinok on Tuesday February 11 2020, @08:15PM   Printer-friendly
from the its-a-pain dept.

Choosing common pain relievers: It's complicated: Researchers examine benefits and risks of nonsteroidal anti-inflammatory drugs:

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


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  • (Score: 2) by barbara hudson on Wednesday February 12 2020, @04:30PM (1 child)

    by barbara hudson (6443) <barbara.Jane.hudson@icloud.com> on Wednesday February 12 2020, @04:30PM (#957225) Journal
    It shows that ordinary folks aren't as stupid as you seem to think. Think of all the women who are NOT diagnosed with a heart attack because their symptoms aren't the same as m n. Doctors miss a lot of shit. Broken bones - doctors looking at xrays failed to find my broken left foot until I broke it a second time - then they saw where it was broken previously. Broken back - multiple visits for X-rays over the years but only detected 8 years later. Broken neck - multiple doctors, multiple xrays - only detected years later. I was right - the doctors were wrong. It took a specialist ordering a full spinal series after I broke another rib to find the breaks because they had healed on a slope.

    I've had 25 or 26 bone fractures - I'll trust my diagnosis over an xray because they miss half of them until years later when you can see the bone callus that forms around the break. Especially if you have preternaturally not-dense-enough bones to begin with (osteopenia, not osteoporosis - I've been breaking bones since my late 20s that shouldn't have broken).

    In the end, any health care decisions are up to the patients, so might as well use the resources out there, such as the online libraries at the national institutes of health, to better inform your decisions, and know what questions to ask.

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  • (Score: 2) by ikanreed on Wednesday February 12 2020, @04:35PM

    by ikanreed (3164) Subscriber Badge on Wednesday February 12 2020, @04:35PM (#957228) Journal

    I don't think people are stupid, save for a few specific counter examples that have removed all doubt as to that truth. I think medicine is a field where actual expertise matters.