Popping Pain Pills Is Not Always The Answer

Most arthritis sufferers do not make a big deal their condition and simply “get on with life as best they can”. When the pain is particularly bad the “go to” solution is a painkiller or anti-inflammatory drug. The common name for these is nonsteroidal anti-inflammatory drugs (NSAID’s).

It is typically only severe cases that require prescription drugs.

What are NSAID’s are how do they work?

Learning how NSAID’s work requires understanding the chemical workings in the body. As you learned earlier, prostaglandins cause the inflammation, which makes you feel pain. What produces the prostaglandins? That would be a chemical known as enzyme COX-2. This chemical behaves a little like a hormone. Your hormones are the chemical substances that are like “traveling messengers” and they control how cells and organs do their work. NSAID’s include a chemical which reduces the production of prostaglandins. This is known as a COX inhibitor.

For a bit more detail these are the functions of COX enzymes in your body:

  • COX-1: protects stomach lining, gastric function, kidney and platelet function.
  • COX-2: inflammation, fever, pain, thromboxane (control of blood clotting and blood vessel constriction), renal function.
  • COX-3: found in the brain, spinal cord and heart. Regulates pain responses and fever.

The very first form of a NSAID was aspirin (1897) – a synthetized form of salacin, produced naturally in willow bark.

In 1961 the first Cox inhibitor drug was introduced (Ibuprofen).

The results were excellent. However, it became apparent that by inhibiting COX-1 and COX-2, the increase in gastro related problems was unacceptable. In 1998 the first COX-2 (specific) inhibitor – Celebrex was launched. A year later Vioxx and Bextra came on the market.

By inhibiting the actions of the COX enzymes, all functions of this enzyme were inhibited.

The gastro related problems were not reduced, and other issues arose as well:

  • Reduced normal renal blood flow
  • Elevated blood pressure
  • Increased water and salt retention
  • Unopposed action of platelet thromboxane (increased the formation of blood clots)
  • Joint deterioration
  • Fracture healing – seriously compromised

These side effects occur gradually, so short-term use is not a major problem – long term (chronic) use becomes a danger.

A trial over 8 – 9 months, with COX-2 inhibiting NSAID’s showed the following results:

  • No reduction in gastro incidents
  • Cardiovascular events were the main cause of deaths
  • Incidents of mortality were higher with COX-2 inhibitors than with non-selective NSAID’s
  • Serious adverse events were significantly higher with selective COX-2 NSAID’s

NOTE: The FDA approved all the above-mentioned NSAID’s

Celebrex is the only COX-2 inhibitor still on sale (plus the various generics). Vioxx and Bextra were withdrawn from the market in 2004 and 2005.

Although the non-specific NSAID’s (inhibiting both COX-1 and COX-2) retains the balance, the gastro danger is increased (ulcers, leaky gut syndrome, etc.).

NSAID’s are not scheduled medicines and are sold over the counter. Therefore, there is no control over how many a person is taking and over what period of time. As already mentioned, short term use is not too serious, but sustained, high dosage use is certainly a potential danger.

NSAID’S minimize the efficacy of blood thinners.

As arthritis tends to affect older people, there is a high probability that they are also taking blood pressure medication and / or anti-coagulants (blood thinners). Many older folk take a “baby aspirin” every day to reduce the risk of strokes. By taking NSAID’s regularly, the efficacy of the aspirin is reduced. Because of the risk of increased blood pressure with NSAID’s the risk of stroke then increases.

Taking warfarin as an anti-coagulant in addition to NSAID’s elevates the likelihood of bleeding in the stomach (and elsewhere).

NSAID’s can be very effective in achieving results, but they must be taken with caution. Using them extensively can cause severe adverse effects and the kidneys can become seriously compromised.

When a person’s immune system is highly efficient, there is a chance that the body will build up a resistance to the drugs as they are seen as “alien” and targeted by the immune system. This is the reason that, taken regularly over a period of time, it seems that the drugs are no longer working very well. This often leads to increased dosage and frequency which exacerbates the health risks.

Take NSAID’s with caution. Be aware of the risk factors and the possibility of serious, sometimes life-threatening, adverse reactions.

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