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Could Your Pain Killer Be Killing You?

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Physicians, pharmacists and patients love NSAIDs (nonsteroidal anti-inflammatory drugs) like ibuprofen (Advil, Motrin, etc.), celecoxib (Celebrex), diclofenac (Cataflam, Voltaren), etodolac (Lodine), ketoprofen (Orudis), meloxicam (Mobic) and naproxen (Aleve, Anaprox, Naprosyn, etc). Billions of such pills are prescribed, dispensed and swallowed every year. It is estimated that over 20 million Americans swallow at least one NSAID every day to relieve arthritis pain as well as discomfort from headaches, sprains and strains.

Because ibuprofen and naproxen are available over the counter we tend to think of them as low-risk drugs. Even with clear instructions about only taking small doses for short periods of time, many people barely bother to read the label. Surveys have discovered that one-fourth of consumers take more than the recommended dose and roughly half are unaware of the potential for NSAID toxicity or just plain don't care.

A new study (The Lancet, online, May 30, 2013) suggests that such a cavalier attitude could kill you. Investigators analyzed data from over 600 clinical trials of NSAID-type pain relievers involving more than 350,000 patients. Here's what they found:

 • NSAIDs like ibuprofen and diclofenac taken in "high doses" for long periods of time are just as likely to cause heart attacks as the drug Vioxx that was pulled off the market several years ago.

• Ibuprofen more than doubled the risk of a "major coronary event" (heart attack or cardiac-caused death) when taken in doses of 2400 mg a day.

• Coxibs  such as celecoxib (Celebrex) or etoricoxib (Arcoxia) raised the risk of a major vascular event by about a third and a major coronary event by two thirds.

 • Naproxen was the least likely NSAID to cause heart attacks and would be our first choice for treating pain or inflammation.

• All these NSAID pain relievers (including naproxen) doubled the risk of congestive heart failure, a serious and potentially deadly heart disorder.

 • All NSAIDs (including naproxen) were implicated in digestive tract disorders including serious or life-threatening bleeding ulcers.

What we do not know is what the risk of NSAIDs might be when taken in lower doses for shorter periods of time. It should not be assumed that such regimens are perfectly safe.

Drug safety experts have estimated that tens of thousands of people died from heart attacks and strokes triggered by Vioxx. It is entirely likely that far more people are dying from other NSAIDs like those listed above.

The FDA is incapable of identifying these drug-induced deaths. One of the highest-level FDA officials admitted to us after the Vioxx scandal that the agency could not detect such deaths because heart attacks and strokes are so common that they couldn't tell when one was caused by a pain reliever like Vioxx and when one was just a "normal" event that would have occurred anyway.

This new research comes on top of a realization that NSAIDs can trigger atrial fibrillation (A-fib) or flutter. These can be serious arrhythmias with devastating consequences. Because the upper chambers of the heart are not beating forcefully, blood clots can form in the left atrium and travel to the brain, leading to a stroke. That is why people who are diagnosed with A-fib are often prescribed blood thinners such as warfarin (Coumadin). Although this anticoagulant can reduce the risk of developing a blood clot and a stroke, it carries its own risks. 

Here are some comments from visitors to this website:

"Quite unfortunately and surprisingly, I was diagnosed with atrial fibrillation earlier this year and now (ugh) I have to take both Coumadin, a blood thinner, and sotolol, a beta blocker. I've never even used an antibiotic! Nothing but homeopathics, herbs, etc. So you can imagine how I feel about having to take those meds!

"Anyway, in researching all the risk factors for that darn A-fib, NSAIDS were cited over and over as a major risk factor for the development of Atrial Fibrillation. I only took 'em on heavy skiing or hiking days, as I've had multiple injuries to both knees. But needless to say, I haven't taken one NSAID since." Cindy

 


"I am on high blood pressure medication and was prescribed meloxicam for a painful back sprain/strain from yard work. Within three days I was in the ER with extremely elevated high blood pressure. Just be careful if you take these types of drugs." Dee


"I was a victim of Vioxx (a COX-2 inhibitor similar to Celebrex) ten years ago this month, nearly died from it. I am still suffering from the A-fib and the effects of the drugs to control it." Hank


 "I can confirm that NSAIDs cause my A-fib. I had bouts with A-fib for several years that got progressively worse. My cardiologist carried out a cardio-version about three years ago and the A-Fib completely went away. But about 6 months ago I strained my back working at my parent's house.

 "My mom gave me a COX2 drug and I also took some ibuprofen that night. My A-fib came back the next day and lasted for a couple of days. I suspected a causal relationship and asked my doctor but he didn't think it was necessarily connected.

 "Then last week I tore my Achilles tendon while traveling overseas. They gave me some diclofenac rub to help with the pain and it really seemed to work. I didn't realize that diclofenac is also a COX-2 drug. After using it a couple of days, my A-fib came back again and is now very persistent. After a week, I still have it and now have to go back to the cardiologist. I'm guessing another cardio-version may be in order.

 "I would like to thank the drug makers for all of the extra money I'm going to have to spend to get my heart back in rhythm. And who knows how many years these drugs have taken off of my life. I would think they would do a better job of warning their customers about this very serious side effect, especially those with a history of A-fib." W.R.A.


Add your own story or comment below. If you would like to learn more about non-NSAID pain relief, check out our book, The People's Pharmacy Quick & Handy Home Remedies or our Guide to Alternative Treatments for Arthritis

We think it is time that the FDA alerted physicians, pharmacists and the public to the dangers of NSAID-type pain relievers. Although no one seems to want to worry about side effects from drugs like ibuprofen, celecoxib, diclofenac or naproxen, we want you to avoid a premature heart attack or stroke. There are other ways to control pain and inflammation that are far less risky!

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Two years ago I suffered from a stroke, the cause of which has still not been determined. I was 53 at the time and in what I thought was tip-top cardio shape. However, in the weeks prior to the stroke, I was taking Advil regularly, mostly as a prophylactic to prevent muscle soreness from some rather intense hiking, as well as sinus-like headaches that had developed.

I called this my "wonder drug" because it was so effective in preventing soreness. After the stroke, which was a watershed event where the symptoms developed gradually, I read about the dangers of ibuprofen and stroke. I haven't touched one since and won't, even though I'm unclear if this had anything to do with it.

My neurologist poo-poo'd this as a potential cause of the stroke, but it is the only thing that makes any sense to me. My arteries were checked and no blockages found.

The good news is that I am recovered now and running and hiking again. I'll gladly suffer muscle soreness and will treat it the old way -- with stretching and ice!

Ok...so what am I going to do about the pain in my calf resulting from stenosis? I had the MILD procedure (laminectomy) and it didn't help one bit. I have done physical therapy for 2 years whole taking 75mg of diclofenac potassium a day.

My pain is under control, but I do worry about taking the NSAID. I am a very active (golf, walking, swimming) 66 year old female.

Thanks for your help.
Marta Y.

I decided just this week to try to stop taking my Celebrex and see if just Tylenol Arthritis would work as well for the pain. I was still hurting even when I was taking Celebrex. Wanted to see if I could see a difference. I am hurting worse but I worry more about inflammation. You say there are other things to use. What are they?

What about aspirin as compared with other NSAIDs? Does it cause the same problems?

People's Pharmacy response: Aspirin does not cause cardiovascular complications like other NSAIDs do.

I was on Vioxx when it first came out, then transitioned to Celebrex for my severe arthritis pain. I'm still on it after many years. I just saw my physician yesterday to talk about pain control, asking if there were an alternative, something between NSAIDs and narcotics. The only thing she suggested was tramadol.

I don't like the side effect profile of that drug either. I have no idea what to do, I'm in chronic pain but can't afford alternative therapies like massage, acupuncture, etc. It is affecting my ability to work and am considering disability. I guess there is no miracle cure, but at least I wish there were drugs that could at least help without the potential to kill you.

I would also like to know whether aspirin has the same problems as other NSAIDs. My doctor recently told me to take advil instead of aspirin for occasional back pain because of potential problems with aspirin, even though I have never had a problem with aspirin. A few years ago a pain management doctor told me that aspirin can cause kidney damage and other problems like any other NSAID, but I couldn't find research to back this up.

People's Pharmacy response: Aspirin does not carry the same cardiovascular risks as other NSAIDs. It certainly can cause gastrointestinal damage, but it seems less likely to cause kidney damage than other popular pain relievers. Of course, that does not mean aspirin never harms the kidneys.

I use Voltaren twice a day for foot and knee pain. How much of this topical would cause a problem?

I try not to use other NSAIDS very often because if I take them every day I start bruising.

I'm not supposed to take acetaminophen due to fatty liver. Ice helps, I may need to just be more diligent with ice.

Are any topical over the counter meds (e.g. Icy Hot) also a problem?

For years I have been prescribed meloxicam for arthritis pain, and I also developed high BP. I disliked or could not tolerate the medications prescribed for HBP.

I decided to take only half of the 15mg meloxicam tabs daily, and I began taking L-argenine daily. My BP has been in an excellent range since then, however, the arthritis in my hands has increased but is tolerable.

I hate it that I started having pounding fast heartbeat after being on diclofenac several days, and my doctors (both family and cardiology) told me there was no connection between diclofenac and heart.

The cardio did a heart monitor test, and found my heart was skipping as many as 400 - 500 bpm, but both doctors assured me it was fine to continue taking the high doses of diclofenac, even though I knew better.

I am a gardener who has some back pain from time to time, and take ibuprofen occasionally. Usually only 400mg once or twice that day, and perhaps 400mg the next day if it is bad. Mostly I try to think about how I am working and avoid stupid maneuvers. I take 1/2 aspirin a day with my vitamins for blood thinning, so I try to wait at least an hour after the aspirin to take the ibuprofen.

My main question is this . . . . what about the impact of an anti-inflammatory diet? I have read about ginger tea, but not really memorized the items that might be inflammation inducing in my diet, nor other inflammation reducers. Can anyone here share foods/drinks that they use to reduce inflammation or things they avoid that have helped with inflammation? I know that the whole inflammation issue also impacts cardio-vascular as well as joints and many other parts of the body.

I also have arthritis and have a lot of hip pain. My doctor's p.a. recommended voltaren gel. I apply only a small amount to the area and I get rapid relief.

I need two knee replacements and have been on Celebrex (after Vioxx) for years. My doc gave me some samples of the new Pennsaid drops, which I believe is similar to the voltaren gel mentioned above. I didn't get much relief from the Pennsaid, but the voltaren sounds worth a try. My job/insurance just ended and I need something generic (and hopefully won't give me a heart attack!). Knee replacements on hold until Medicare kicks in. Tramadol has been suggested, but I see that comes with its own problems.

I've been on 650-2600 mgm of enteric coated aspirin daily since 1968, 45 years, with no adverse side effects. I keep telling people this but no one listens. Throw out the garbage, take the basic.

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