Is your pain reliever the best choice for your overall health?
The American Heart Association (AHA) is advising doctors to change the way they prescribe pain relievers for the treatment of chronic pain. This warning covers all types of nonsteroidal anti-inflammatory drugs (NSAIDs), with the exception of aspirin, and comes after much evidence that these drugs increase the risk of heart attack and stroke.
The AHA's recommendations may entirely change the way chronic pain is managed.
The warning specifically targets so-called Cox-2 inhibitors, a type of prescription NSAID that is sometimes used as the first line of treatment against chronic pain and some cases of acute pain. Instead of being the first option for patients looking for relief, says Dr. Elliott Antman, lead author of the AHA's official statement, Cox-2 inhibitors should be used only as a last resort, when other pain treatments have failed. Celecoxib (Celebrex) is currently the only Cox-2 inhibitor on the market in the United States.
Antman advises that before turning to medication, doctors look first to treatments that avoid drug use altogether for chronic pain conditions, such as arthritis. This may include physical therapy, exercise and heat or cold therapy. Weight loss should also be considered for those who are overweight or obese, as a lighter body could reduce the strain on joints.
If these treatments don't work, says Antman, only then should drugs be tried. Over-the-counter pain relievers , such as ibuprofen, acetaminophen and aspirin, should be used at their smallest effective doses.
Then, if all other measures fail, only then should a doctor consider prescribing a Cox-2 inhibitor, according to the American Heart Association. Again, these drugs should be taken at the lowest dose necessary and for the shortest amount of time possible to reduce heart risks.
Doctors will prescribe Cox-2 inhibitors in some cases. For example, recent research suggests that short-term use of these medications may be safe for people with irritable bowel syndrome, which other NSAIDs may aggravate.