Ibuprofen, For Better or For Worse

Aches and pains? A hangover?

A knee-jerk response is all too often to reach for a bottle of an NSAID drug such as ibuprofen or naproxen.

Non-steroidal anti-inflammatory drugs or NSAIDs are a class of medications commonly used to treat analgesic and anti-inflammatory conditions. And there are lots of them out on the market today. In my practice, however, I deal with their severe side effects. Turns out NSAIDs have one of the highest rates of potential negative side effects of any class of drugs. And we are not just talking about mere illness, but side effects that can result in death.

Gastrointestinal, neurologic, renal, and allergic effects of non-aspirin non-steroidal, anti-inflammatory drugs are responsible for approximately 12 percent of hospital admissions due to an adverse response. I do not want to unduly scare everyone, but popping these pills like M & Ms is not a good idea. Take these drugs judiciously and be very aware of what can happen.

Before we drill down to those details, let’s instead focus on more natural ways for dealing with pain and inflammation.

Turmeric is an amazing spice. Ground from the root of a plant (Curcuma longa L.) from the ginger family, found wild in the Himalayas, and grown across South Asia, turmeric powder is surprisingly bland, not hot, tangy or peppery. The November 2006 issue of Arthritis & Rheumatism suggested that turmeric, one component of curry spice, almost completely prevented joint swelling in rats with arthritis. We often use this spice in treating patients with inflammatory bowel disease from migratory arthritis.

Clinical trials, testing a preparation of the turmeric powder mixed with essential oils in a gelatin capsule, are currently taking place, targeting patients with steroid-dependent Crohn’s disease (of the colon) and ulcerative colitis.

Other studies indicate the spice could protect against diseases such as heart disease, cancer, and Alzheimer’s, a degenerative brain disease.

Then there are ice packs, rest, elevation, and sometimes compression, all potent agents when dealing with pain following an injury.

Chronic arthritis often benefits from exercise programs such as water aerobics, stretching or a regular yoga practice. Omega-3 agents (fish oil and flax seed oils for examples) in significant doses are sometimes added to the program to avoid NSAID agents in our patients.

Now on to the potential side effects of NSAID drugs which, as I said, I consider one of the riskiest class over-the counter drugs.

1. Although rare, these agents have been associated with liver injury, which may present as abnormal liver enzyme tests in routine blood work.

2. They can also cause renal or kidney damage. NSAIDs can induce several different forms of kidney injury including hemodynamically-mediated acute kidney injury, electrolyte and acid-base disorders, and acute interstitial nephritis, all of which can be quite significant.

3. Can these agents also affect your heart?

When thinking about cardiovascular risk for patients treated with NSAIDs, it is important to consider the duration and frequency of therapy. Unlike the gastrointestinal side effects, which can occur soon after initiation of therapy, the risk of adverse cardiovascular events such as myocardial infarction, stroke, or cardiovascular death is extremely small over the course of treatment in patients with an acute, but limited musculoskeletal injury for example.

There is an increased risk, however small, of heart failure, stroke, heart attack (MI), and death. The magnitude of the risk is best illustrated by a 2013 meta-analysis of predominantly individual participant data from randomized trials that compared nonselective NSAIDs with either placebo or another nonselective NSAID. The analysis utilized data from over 300,000 participants in over 600 trials. After follow-up of approximately one year, the meta-analysis found major cardiovascular events (a composite of nonfatal MI, nonfatal stroke, or vascular death) were significantly increased compared with placebo for high-dose called diclofenac, a NSAID.

4. Nonselective NSAIDs can raise the blood pressure.

5. Nonselective nonsteroidal antiinflammatory drugs have potentially important gastrointestinal adverse effects, which include dyspepsia, peptic ulcer disease, and bleeding. Death can happen from a perforation of the stomach from an ulcer or from a massive bleed. A week never goes by that we do not see a patient with a massive bleed or perforation sometimes resulting in death from these agents.

We always assume we can avoid the side effects if we take the NSAID with meals, but this is very often not protective. Most side effects are secondary to the effects these agents have on our stomach after absorption into our blood stream.

6. NSAIDs can also flare pre-existing inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.

7. There is a small potential impact on fracture healing from the use of nonselective nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase (COX)-2 selective agents.

And that’s not the end of the story, so it is best to always discuss chronic usage with your physician.

If chronic use is needed, please have blood work regularly to look for renal and liver damage and always keep in mind that most of the gastrointestinal side effects are silent until the patient develops a significant ulcer, perforation, or bleed. Think about more natural ways of treatment before picking up a bottle of your favorite NSAID.

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