Not All Oldies Are Goodies
September 15, 2001 | 12:00am
The phrase "an oldie but a goodie" may apply to old time favorite tunes, but may not apply to the old and traditional way of treating chronic and acute pain. Since the 70’s, when a person experienced pain he would conveniently reach for a pain killer like an NSAID (Non-Steroidal Anti-Inflammatory Drug) such as ibuprofen, aspirin, diclofenac, naproxen, etc. But now, with the emergence of new breakthrough pain medications, older has not proven to be necessarily better.
So what’s wrong with these traditional pain killers? Many studies and documented cases have shown a connection between NSAIDs and ulcers. A 49-year old patient named Lani was rushed to a hospital emergency room in the middle of the night because she had excruciating stomach pain. She had been regularly using an NSAID for Osteoarthritis pain in her knees, and had noticed an increase in stomach upset with heartburn, belching and bloating. She was in terrible pain and the hospital staff wondered if she needed emergency surgery. After several tests, it was determined that she had gastric ulcer. Lani was immediately taken off the NSAID and was given antacids to block the acid in her stomach. But then, she was at a loss as to what pain reliever would be safe for her.
Lani’s case is just one of so many cases. So what caused her gastric ulcers? NSAIDs, though widely used and easily bought over-the counter, are known to diminish the protective lining in the stomach because of its inhibitive effect on both Cyclooxygenase 1 & 2 (COX-1 & COX-2). The enzyme COX-1 produces prostaglandin which naturally protects the stomach lining, while COX-2 prostaglandin is responsible for pain. Without COX-1 prostaglandin, the stomach is vulnerable to irritation, perforations, even bleeding.
NOT ALL OLDIES ARE GOODIES – WHEN TREATING PAIN
Here are some facts and statistics –
• If you use NSAIDs, you have a 30% chance of incurring stomach and intestinal damage like perforations, ulcers and stomach bleeding. While an estimated 70% experience some form of minor gastrointestinal side effect, such as heartburn and nausea.
• 50% of those who sustain stomach damage develop peptic ulcers.
• Peptic ulcers may be silent and produce no symptoms.
• Of the 13 Million Americans who use NSAIDs to treat arthritis and pain, up to 100,000 are hospitalized annually for complications caused by the drugs such as ulcers, bleeding and small perforations – most without warning or symptoms.
• More than 16,500 people in the U.S. die every year due to gastro-intestinal side effects associated with the use of NSAIDs.
• Other factors that can increase the risk of NSAID-induced ulcers include: a history of GI complications or cardiovascular disease, use of oral corticosteroids (drugs used for the treatment of rheumatoid arthritis, asthma, inflammatory bowel disease, etc.) or anticoagulants (anti-blood clotting drugs), cigarette smoking and alcohol consumption.
Doesn’t sound so good. This ‘old’ way of treating pain, though proven effective in relieving pain and inflammation, may cause gastrointestinal side effects. In fact, if not properly monitored, these side effects can lead to stomach problems, kidney damage, even death.
The ‘new’ generation of pain relievers classified as Coxibs eliminates these side effects. Dr. Adriano V. Laudico, a noted surgeon and chair of the Pain Management Information Agency (PMIA), recommends coxibs like VIOXX (rofecoxib) to his patients when treating pain. Even for postoperative pain, Dr. Laudico finds rofecoxib effective in combination with morphine which he has tried personally after having been operated on. He places great importance on safety and efficacy when prescribing pain medications to his patients. He strongly believes that pain relief need not compromise the other aspects of the person’s health and well being. He advises people to learn more about the benefits and side effects of the pain relievers they are currently taking. He also recommends patients to consult with their doctors before taking pain medications.
For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.
So what’s wrong with these traditional pain killers? Many studies and documented cases have shown a connection between NSAIDs and ulcers. A 49-year old patient named Lani was rushed to a hospital emergency room in the middle of the night because she had excruciating stomach pain. She had been regularly using an NSAID for Osteoarthritis pain in her knees, and had noticed an increase in stomach upset with heartburn, belching and bloating. She was in terrible pain and the hospital staff wondered if she needed emergency surgery. After several tests, it was determined that she had gastric ulcer. Lani was immediately taken off the NSAID and was given antacids to block the acid in her stomach. But then, she was at a loss as to what pain reliever would be safe for her.
Lani’s case is just one of so many cases. So what caused her gastric ulcers? NSAIDs, though widely used and easily bought over-the counter, are known to diminish the protective lining in the stomach because of its inhibitive effect on both Cyclooxygenase 1 & 2 (COX-1 & COX-2). The enzyme COX-1 produces prostaglandin which naturally protects the stomach lining, while COX-2 prostaglandin is responsible for pain. Without COX-1 prostaglandin, the stomach is vulnerable to irritation, perforations, even bleeding.
NOT ALL OLDIES ARE GOODIES – WHEN TREATING PAIN
Here are some facts and statistics –
• If you use NSAIDs, you have a 30% chance of incurring stomach and intestinal damage like perforations, ulcers and stomach bleeding. While an estimated 70% experience some form of minor gastrointestinal side effect, such as heartburn and nausea.
• 50% of those who sustain stomach damage develop peptic ulcers.
• Peptic ulcers may be silent and produce no symptoms.
• Of the 13 Million Americans who use NSAIDs to treat arthritis and pain, up to 100,000 are hospitalized annually for complications caused by the drugs such as ulcers, bleeding and small perforations – most without warning or symptoms.
• More than 16,500 people in the U.S. die every year due to gastro-intestinal side effects associated with the use of NSAIDs.
• Other factors that can increase the risk of NSAID-induced ulcers include: a history of GI complications or cardiovascular disease, use of oral corticosteroids (drugs used for the treatment of rheumatoid arthritis, asthma, inflammatory bowel disease, etc.) or anticoagulants (anti-blood clotting drugs), cigarette smoking and alcohol consumption.
Doesn’t sound so good. This ‘old’ way of treating pain, though proven effective in relieving pain and inflammation, may cause gastrointestinal side effects. In fact, if not properly monitored, these side effects can lead to stomach problems, kidney damage, even death.
The ‘new’ generation of pain relievers classified as Coxibs eliminates these side effects. Dr. Adriano V. Laudico, a noted surgeon and chair of the Pain Management Information Agency (PMIA), recommends coxibs like VIOXX (rofecoxib) to his patients when treating pain. Even for postoperative pain, Dr. Laudico finds rofecoxib effective in combination with morphine which he has tried personally after having been operated on. He places great importance on safety and efficacy when prescribing pain medications to his patients. He strongly believes that pain relief need not compromise the other aspects of the person’s health and well being. He advises people to learn more about the benefits and side effects of the pain relievers they are currently taking. He also recommends patients to consult with their doctors before taking pain medications.
For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.
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