The chronic use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be restricted to those conditions that have not responded to more natural means or methods. Always deal with the underlying causes when known or possible. Side-effects vary among different NSAIDs with some being safer than others. Consider using the lowest possible dose to accomplish the job. If you are taking them already and tolerating them well, the reduced risk of Alzheimer’s disease may be another very motivating reason to continue.
Due to the detrimental effects of NSAIDs on the body, most physicians resort to a game of “NSAID musical-chairs,” taking a patient off one NSAID as soon as side effects become evident or the drug stops working, then treating the patient with another of the 10 most widely prescribed propionic acid-derived NSAIDs.
To provide a more consistent form of treatment, researchers have long searched for a side-effect free anti-inflammatory agent. Researchers have focused on selective cyclo-oxygenase (COX-2) inhibitors, more precise versions of NSAIDs. Whereas previous NSAIDs reduced inflammation by inhibiting all cyclo-oxygenase activity, these new selective COX-2 inhibitors (Celebrex, Vioxx, Bextra) differentiate between the two forms of COX: COX-1 appears to regulate many normal physiologic functions and COX-2 mediates the inflammatory response. These selective inhibitors are believed to reduce inflammation without influencing normal physiologic functions by inhibiting only COX-2. By leaving COX-1 alone, the selective inhibitors result in fewer gastrointestinal side effects.
Upon further inspection, however, Celebrex (celecoxib) use has been associated with headaches, change in bowel habits, abdominal discomfort and dizziness in osteoarthritis patients. Fewer adverse effects are reported in rheumatoid arthritis patients, but because the drug is metabolized in the liver by cytochrome P-450 isozyme CYP2C9, drug interactions are possible. Celebrex has generally gained popularity over Vioxx because of concerns that Vioxx use will increase the risk of heart related side effects. Further, the use of Celebrex is being questioned regarding whether there really is a reduced risk of stomach ulcers.
On September 30, 2004: “The Food and Drug Administration (FDA) acknowledged the voluntary withdrawl from the market of Vioxx (chemical name rofecoxib). Celebrex and Bextra were still available at that time.
The blockbuster painkiller Bextra was pulled off the market April 7, 2005, and the US government ordered that 19 other popular prescription competitors – from Celebrex to Mobic to high-dose naproxen – carry tough new warnings that they, too, may increase the risk of heart attacks and strokes.
NSAIDs can help with the following
Parkinson's Disease / Risk
Naproxen and other NSAIDs may exacerbate Parkinson’s disease.
Microscopic Colitis (Collagenous Colitis / Lymphocytic Colitis)
The use of NSAIDs including aspirin for those with microscopic colitis may prevent successful treatment or cause relapses following treatment.
Gastric/Peptic Ulcers
Prostaglandins are substances that are important in helping the gut linings resist corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach. However, those who use NSAIDs may have a special need for supplemental glutamine. Fortunately, sufficient glutamine can undo the damage caused by NSAIDs, maintaining permeability at a healthy level. For heavy NSAID users, supplementing with glutamine can spell the difference between healthy gastrointestinal tract versus ulcers and the “leaky gut syndrome.” If you have symptoms that could be from stomach or peptic ulcers, NSAIDs should be avoided until these conditions are ruled out.
Psoriatic Arthritis
NSAIDs are often used to treat psoriatic arthritis. NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as aspirin and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding.
Episcleritis
Treatment for episcleritis is usually not needed. Chilled artificial tears can be used to soothe the eye and reduce mild inflammation. In more severe cases of episcleritis, mild steroids and anti-inflammatory medications are prescribed to reduce inflammation.
Costochondritis
Nonsteroidal anti-inflammatory medications (e.g. Motrin, Advil) help decrease the pain and the inflammation, which is the primary problem. Check with your doctor before taking NSAIDs as they have potential side-effects.
Osteoarthritis
NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are commonly used to treat osteoarthritis. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. Acetaminophen such as Tylenol can also be very effective in treating the pain. Research has shown that in many patients acetaminophen relieves pain as effectively as NSAIDs. These pain killers will only help control the symptoms, and if used at all should only be used for pain control while more effective therapies are at work. The newer COX2 inhibitors will have fewer side effects, but still do not restore normal function. Topical pain-relieving creams, rubs and sprays can be applied directly to the skin. There are many brands available over the counter.
Low Back Pain / Problems
Use pain medication, if necessary, such as Tylenol, Aleve or another NSAID such as aspirin as needed during the acute phase of the injury.
Increased Risk of Alzheimer's / Dementia
At least twenty studies suggest that Ibuprofen and other NSAIDs – common non-prescription drugs – may slow or prevent the onset of Alzheimer’s disease by as much as 60%. Researchers say it also opens up a new way to think about how Ibuprofen protects the brain.
“We’ve shown that a drug that’s available, that’s been in use for 30 to 40 years, and for which we know the side-effect profiles… can reduce both the inflammatory response to amyloid and the amyloid itself”, says study leader Gregory M. Cole of the University of California in Los Angeles.
Note that NSAIDs can cause serious stomach problems, including bleeding. Investigators therefore hesitate to recommend widespread use of the drugs until they can develop safer versions.
Certain NSAIDs work by decreasing the levels of amyloid-beta 42 rather than by inhibiting cyclooxygenase, as was once proposed. Advil (Ibuprofen) is the most effective, requiring as little as 800mg per day to reduce the risk of Alzheimer’s without serious side-effects. Other NSAIDs require much higher doses to achieve this benefit, while aspirin, Naproxen and celeloxib (Celebrex) were found ineffective.
Increased Risk of Colon Cancer
Aspirin and other NSAIDs have been previously reported to protect against the development of colorectal cancer. [ Gastroenterology, March 1998]
Colon Polyps
Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) could act to prevent the development of polyps in the colon, which are precursors to most colorectal cancers. In one study, patients who took aspirin or other NSAIDs more than 15 times per month at some time during the five years prior to the study were defined as “regular users”; patients who never took medication more than 15 times per month were defined as “non-users”. After accounting for factors such as diet, lifestyle and family medical history, Dr. Sandler found that regular users of aspirin and other NSAIDs were only half as likely to harbor colon polyps as non-users.
“Our study supports the idea that some mechanism in aspirin and other NSAIDs has a protective effect when it comes to colon cancer,” said Dr. Sandler. “More significantly, our results indicate that this protective effect occurs early in the process of cancer development, helping us to pinpoint where in the cancer development sequence these drugs might work best.” [ Gastroenterology, March 1998]
In addition, colon polyps have dissappeared after treatment with NSAIDS. It was found that nearly 80% of patients with sporadic colon polyps, the type that can develop into common colon cancer, had their polyps disappear or shrink after taking sulindac, a nonsteroidal anti-inflammatory drug (NSAID), for one year.
Dysmenorrhea, Painful Menstruation
Ibuprofen and naproxen sodium are common over-the-counter medications that can help relieve menstrual cramps.
Key
| May do some good |
| Likely to help |
| Highly recommended |
| Reasonably likely to cause problems |
| Avoid absolutely |
Glossary
NSAID
Non-steroidal anti-inflammatory drug.
Arthritis
Inflammation of a joint, usually accompanied by pain, swelling, and stiffness, and resulting from infection, trauma, degenerative changes, metabolic disturbances, or other causes. It occurs in various forms, such as bacterial arthritis, osteoarthritis, or rheumatoid arthritis. Osteoarthritis, the most common form, is characterized by a gradual loss of cartilage and often an overgrowth of bone at the joints.
Chronic
Usually Chronic illness: Illness extending over a long period of time.
Anti-inflammatory
Reducing inflammation by acting on body mechanisms, without directly acting on the cause of inflammation, e.g., glucocorticoids, aspirin.
Gastrointestinal
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Rheumatoid Arthritis
A long-term, destructive connective tissue disease that results from the body rejecting its own tissue cells (autoimmune reaction).
Stomach
A hollow, muscular, J-shaped pouch located in the upper part of the abdomen to the left of the midline. The upper end (fundus) is large and dome-shaped; the area just below the fundus is called the body of the stomach. The fundus and the body are often referred to as the cardiac portion of the stomach. The lower (pyloric) portion curves downward and to the right and includes the antrum and the pylorus. The function of the stomach is to begin digestion by physically breaking down food received from the esophagus. The tissues of the stomach wall are composed of three types of muscle fibers: circular, longitudinal and oblique. These fibers create structural elasticity and contractibility, both of which are needed for digestion. The stomach mucosa contains cells which secrete hydrochloric acid and this in turn activates the other gastric enzymes pepsin and rennin. To protect itself from being destroyed by its own enzymes, the stomach’s mucous lining must constantly regenerate itself.
Ulcer
Lesion on the skin or mucous membrane.
FDA
The (American) Food and Drug Administration. It is the official government agency that is responsible for ensuring that what we put into our bodies - particularly food and drugs - is safe and effective.