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ibuprofen

Cardiovascular Safety of Pain Meds Questioned

A meta-analysis recently published in the British Medical Journal questions the safety of common pain medications.  This article, which can be found here, analyzed 31 trials which contained 116,429 patients with more than 115,000 patient years of follow-up. These trials compared one type of non-steroidal anti-inflammatory medication (NSAID) to another, or to placebo. They looked for outcomes such as heart attack, stroke or death from cardiovascular disease.

They concluded that “little evidence exists to suggest that any of the investigated drugs are safe in cardiovascular terms. Naproxen seemed least harmful.” Vioxx and Prexige had the highest risk of heart attack, while ibuprofen and diclofenac showed the highest risk of stroke.

It should make us take pause that one of the most common over the counter pain medications (ibuprofen) was associated with a 3-times higher risk of stroke when compared to placebo. We need to start educating ourselves on the real risks associated with quick-fixes for pain, and start looking to treat the cause of our pain and not just the symptoms. Manual therapies such as chiropractic are a drug-free, non-surgical, safe and effective option.

The CBC has a somewhat-simplistic but interactive comparison of the 3 major over the counter pain relievers here.

Dr. Debbie Wright is a practicing Courtenay Chiropractor.

Pain Medication Reduces Breast Cancer Risk?

Nothing irritates me more than reading incredibly misleading health related headlines in the Vancouver Sun with my morning coffee. Thus was the case this week when I was greeted with this headline upon sitting down in the kitchen: “Aspirin May Prevent Breast Cancer“.

Now, before you run out and start buying Costco sized aspirin bottles, let’s take a closer look at this study. First of all, its an observational study which means that an association was found between women who take pain relievers and a lower risk of breast cancer. It is important to note that an association does not necessarily equal causation (i.e. the drugs don’t necessarily cause a lower breast cancer risk).

Off the top of my head, I can give you one scenario that could be occurring. Maybe women who are more active have more aches and pains from exercise, and therefore take more pain relievers. The increased exercise could be causing the lowered breast cancer risk and the drugs are just a co-incidence. That’s the problem with an observational study – you aren’t controlling for many of these factors that can confound the results. A randomized controlled trial is needed to find clearer answers.

More importantly though, the toxicity of common pain relievers is enough in my mind to neutralize any benefit in terms of a reduced cancer risk. The authors of the study go so far as to admit that NSAID drugs such as ibuprofen (non-steroidal anti-inflammatories) have too high levels of gastrointestinal and cardiovascular adverse effects.

A very comprehensive evidence-based review of NSAID toxicity can be found here. While most of the data is based in the UK, they do list some interesting numbers for the US and Canada.  I’ve reproduced the summary table here:

Table 2: NSAID-related deaths and admissions to hospital

Event UK USA Canada
Annual NSAID prescriptions 25 million 70 million 10 million
NSAID-related admissions 12,000 100,000 3,900
NSAID-related deaths 2,600 16,500 365

In my opinion, that’s a staggeringly high number of deaths for something that is essentially just treating the symptoms of a problem. I’ve stopped being surprised at the sheer proportion of my patients who have absolutely no clue that NSAID medication carries any risks. They assume (as do most people) that since its available over the counter that it must be safe. Relatively speaking it is, but nothing comes without risks.

The bottom line from your Comox Valley Chiropractor? Think twice before you pop that ibuprofen like candy day after day, and look past the headlines when dealing with health related news!