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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 DannyB on Wednesday February 12 2020, @06:12PM (8 children)

    by DannyB (5839) Subscriber Badge on Wednesday February 12 2020, @06:12PM (#957304) Journal

    Not me.

    --
    People today are educated enough to repeat what they are taught but not to question what they are taught.
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  • (Score: 2) by RS3 on Wednesday February 12 2020, @06:19PM (7 children)

    by RS3 (6367) on Wednesday February 12 2020, @06:19PM (#957309)

    Me neither, but I don't have problems that need it. It was prescribed to my father, but I don't know why, and he's not with us anymore to ask him about it... Might be something for you to look into- my dad's doctor was voted best doctor in a major metropolitan area many years.

    • (Score: 2) by DannyB on Wednesday February 12 2020, @06:25PM (6 children)

      by DannyB (5839) Subscriber Badge on Wednesday February 12 2020, @06:25PM (#957314) Journal

      A weird drug, IMO, is Tramadol. My arthritis dr had me try it instead of hydrocodone in, about, 2010. Take it every day he said.

      I got jittery. Couldn't keep my limbs and extremities still. Had to always be shaking of moving them. Had some trouble sleeping. It was like an electric current almost. Also it was definitely addictive. Withdrawal symptoms were no fun either. I quit it and never looked back. I don't find hydrocodone addictive, but I'm sure it can be from all I hear. I hated Tramadol. Have no problem of any recognizable kind with hydrocodone.

      --
      People today are educated enough to repeat what they are taught but not to question what they are taught.
      • (Score: 4, Informative) by Azuma Hazuki on Thursday February 13 2020, @01:55AM (5 children)

        by Azuma Hazuki (5086) on Thursday February 13 2020, @01:55AM (#957536) Journal

        Tramadol is a well-known serotonergic. That sounds like low-grade serotonin syndrome, and it's a major reason tramadol is not recommended to be mixed with SSRIs, triptans, or other serotonin agonists.

        Fun story: about 5 years ago I was prescribed tramadol and cyclobenzaprine (Flexeril), the latter of which is a muscle relaxant that looks almost exactly like a tricyclic antidepressant like amitryptiline. I remember just staring at the bottles and asking if they were trying to kill me. They looked like the carpet had just leapt off the floor and bitten them; they were evidently not expecting a "civilian" to know one end of a vial from another! This is the event that got me really interested specifically in pharmacology, as opposed to my generalized organic-chem nerdistry from elementary school: it was self-defense.

        --
        I am "that girl" your mother warned you about...
        • (Score: 2) by RS3 on Thursday February 13 2020, @02:37AM (2 children)

          by RS3 (6367) on Thursday February 13 2020, @02:37AM (#957564)

          So, I have to ask, have you looked into going to med school?

          • (Score: 2) by Azuma Hazuki on Friday February 14 2020, @01:21AM (1 child)

            by Azuma Hazuki (5086) on Friday February 14 2020, @01:21AM (#957971) Journal

            With no money, almost 40K in student debt, and having been lifelong poor? Hah. Not in this country. One of the reasons I'm trying to get into Soviet Canuckistan is the possibility of perhaps going to pharmacy school there. This country? The US wants me and all the other poors dead.

            --
            I am "that girl" your mother warned you about...
            • (Score: 2) by RS3 on Friday February 14 2020, @02:13AM

              by RS3 (6367) on Friday February 14 2020, @02:13AM (#958011)

              GoFundMe?

              Cuba?

        • (Score: 2) by DannyB on Thursday February 13 2020, @02:52PM (1 child)

          by DannyB (5839) Subscriber Badge on Thursday February 13 2020, @02:52PM (#957722) Journal

          Another thing about Tramadol I forgot to mention: I was in a really good mood all the time.

          That's just not natural. I distinctly recognized it, that I was always in a good mood on that drug. I didn't like it. It's not normal to always be in a good mood constantly.

          --
          People today are educated enough to repeat what they are taught but not to question what they are taught.
          • (Score: 2) by Azuma Hazuki on Friday February 14 2020, @01:22AM

            by Azuma Hazuki (5086) on Friday February 14 2020, @01:22AM (#957972) Journal

            I had Tramadol once. *Once.* It made everything all better. I didn't feel numb or disconnected; for the first time in decades, I felt *safe.* And I knew, right then and there, that I could never ever have it again. That kind of thing hooks people.

            --
            I am "that girl" your mother warned you about...