|(ARA) – Karen Woolery has struggled with arthritis in her hands for the past 12 years, making her job as director of a day care physically difficult. The arthritis made even the simplest movements painful. To relieve the pain, she often took medications like ibuprofen, never realizing they could potentially cause her harm. Her doctors soon discovered Karen had a big problem – she had ulcers.
|Woolery learned that those pain relievers, also known as non-steroidal anti-inflammatory drugs (NSAIDs), had caused her ulcers.
NSAIDs which include aspirin, ibuprofen and naproxen are the most widely used drugs in the United States. Every day, more than 30 million Americans use NSAIDs for pain from headaches, arthritis and other conditions. In fact, it is estimated that more than 60 million Americans use NSAIDs regularly. Two to 4 percent of users – or over a million individuals, like Woolery – will experience serious complications from NSAID use, such as ulcers, each year.
“Many patients do not realize the risks associated with taking NSAIDs, such as nausea, heartburn, ulcers or complications from ulcers, and that the side effects can occur at any time regardless of whether you’ve taken an NSAID for a week or for a year,” says Dr. Byron Cryer, professor of Internal Medicine – Digestive and Liver Diseases at Dallas VA Medical Center and University of Texas Southwestern.
NSAIDs, which may be over-the-counter or prescription medications, work by blocking enzymes that prevent the body from making a hormone called prostaglandin that causes inflammation and pain. By preventing the body from making prostaglandin, the lining of the stomach and upper gastrointestinal tract becomes weakened, which makes a person more susceptible to serious GI complications such as bleeding, ulceration and perforation, often without warning or symptoms.
A number of factors may increase a patient’s risk for NSAID-associated GI ulcers and their complications. Risk factors include age, history of GI complication, use of corticosteroids or anticoagulants, cardiovascular disease, use of multiple NSAIDs, chronic use of NSAIDs and high-dose NSAIDs. For example, people taking low-dose aspirin for cardiovascular protection in addition to another NSAID have a two- to four-fold increased risk of gastrointestinal bleeding – a major and potentially life-threatening complication – compared with those not taking these medications together.
“I had no idea that taking a medicine for pain could be so harmful,” says Woolery. “I always thought that my stomach ache was due to something else. I never talked to my doctor about the fact that there are side effects involved with taking NSAIDs.”
According to Cryer, the “safety” of over-the-counter pain drugs is a common misperception. In fact, a study conducted by physicians at Eastern Virginia Medical School found that 22 percent of patients responding to the survey did not think that over-the-counter medications were important enough to list to their physicians. The study concluded that the perception that over-the-counter NSAIDs are benign is precisely the reason patients and their physicians need to discuss all NSAID use.
Understanding and reducing the GI risks associated with the use of NSAIDs is becoming an increasingly important part of patient care for primary care physicians and rheumatologists. Not every patient will require NSAID therapy, but those who do should work with their physician to determine whether taking a low dose would be an effective way to manage pain and inflammation.
For those who need a higher dose of NSAIDs, physicians may decide to add a GI protective therapy to reduce the risk of ulcers and more serious upper GI complications. GI protective therapies are medications that are already commonly found both over-the-counter and by prescription, and primarily fall into two categories – H2 antagonists and proton pump inhibitors (PPIs). H2 antagonists are products like famotidine (Pepcid), while PPIs include products like lansoprazole (Prevacid), omeprazole (Prilosec), esomeprazole (Nexium) and pantoprazole (Protonix). Another less common therapy that may be used is misoprostol (Cytotec). Celecoxib (Celebrex), a COX-2 specific NSAID, may also be considered an option for some patients.
“The good news is that for people who take NSAIDs, there are options to address GI risks,” says Cryer. “In the near future, we may see even more effective treatments that address both pain relief and potential GI complications in a single pill.”
With the right information from her physician, Woolery now has the tools to better manage her pain and help keep the ulcers from coming back. She hopes her experience will encourage others to learn more about the risks associated with NSAID usage.
“I had no idea of the risks, but others can learn from my experience and speak to their doctor,” she says.
Courtesy of ARAcontent