People in pain are caught between a rock and a hard place. On the one hand, they have to deal with sore joints or chronic back problems that make it hard to enjoy everyday activities. On the other hand, the pain relievers they count on to ease their discomfort pose serious risks.
We have known for decades that nonsteroidal anti-inflammatory drugs (NSAIDs) can be irritating to the digestive tract. That's true whether someone is taking a prescription like diclofenac (Cataflam or Voltaren) or an over-the-counter pain reliever such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Regular use may lead to life-threatening bleeding ulcers.
Vioxx and Celebrex were supposed to be safer for the digestive tract. But when Merck revealed that Vioxx increased the risk for heart attacks and strokes, scientists started looking at all pain relievers. What they found is deeply disturbing.
Researchers who studied nearly 100,000 people between 2000 and 2004 found that those taking Vioxx were more likely to suffer heart attacks than those taking no pain relievers. But those taking ibuprofen were 24 percent and those taking diclofenac were 55 percent more likely to have a heart attack (British Medical Journal, June 11, 2005).
A new study just out may offer one possible explanation (Archives of Internal Medicine, Feb. 26, 2007). Investigators followed 16,000 male health professionals for four years. Those who regularly took pain relievers had a greater likelihood of being diagnosed with high blood pressure.
Men taking NSAIDs six or seven days a week had 38 percent greater risk of hypertension. Those who took acetaminophen (Tylenol) that often had a 34 percent higher chance of that diagnosis.
Most people assume that acetaminophen is relatively safe since it is unlikely to cause stomach irritation. But the new finding that it too may affect blood pressure means that people in pain have no easy options.
Even aspirin may pose a risk. Although it helps protect men and women from heart attacks, the male health professionals who took aspirin daily were also one fourth more likely to have elevated blood pressure than those who took nothing.
For those without any risk of heart disease, such drugs may offer more benefit than harm as long as blood pressure is carefully monitored. But 65 million Americans have hypertension and most do not control it adequately. For them, relying on acetaminophen, ibuprofen or other popular pain relievers could promote this "silent killer."
Hypertension increases the risk of heart attacks, strokes, kidney disease and dementia. Treating it with medication while you are taking a pain reliever may be a little like running up stairs with lead overshoes.
The American Heart Association has responded to the new research with a recommendation that physicians first try non-drug treatments for their patients in pain. They suggest physical therapy, exercise, weight loss and heat or cold therapy.
To learn more about other non-drug approaches such as vitamin D, fish oil, glucosamine and chondroitin, cherry or pomegranate juice, magnets and anti-inflammatory herbs, consider Best Choices From The People's Pharmacy (Rodale Books).