NSAIDs for pain

Have you taken nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac, ibuprofen or naproxen? A recent study shows that people taking high doses of NSAIDs for pain may develop kidney problems (Nelson et al, JAMA Network Open, Feb. 15, 2019).

Studying NSAIDs for Pain Relief:

Previous studies have shown that using NSAIDs for pain can increase biomarkers of kidney damage. Some of those studies focused on older adults, who are at higher risk. However, at least one meta-analysis also found problems among younger people. The new study used de-identified medical records of more than 750,000 active duty US Army soldiers. Consequently, these were active young and middle-aged adults. The study included records from 2011 through 2014. During that time, nearly 18 percent of these soldiers got a prescription for one to 7 doses of an NSAID pain reliever in a month. Another 16 percent were prescribed more than 7 doses in a month.

Consequences of Taking NSAIDs for Pain:

Fewer than 1 percent of these people were subsequently diagnosed with acute or chronic kidney disease. Nevertheless, the rate of kidney trouble was about 20 percent higher among people who had received high-dose NSAIDs than among those who had taken none. The absolute risk of acute kidney injury was 3 in 1,000. Additionally, the absolute risk of chronic kidney disease was only slightly lower, at 2 in 1,000. These healthy, active young people should have little likelihood of kidney disease. The authors describe this increased risk as modest but statistically significant.

They state:

“These potentially preventable cases are of particular concern in a population in which medical readiness is a foundation of national security. Because most participants were younger than 35 years and free of hypertension, diabetes, and/or rhabdomyolysis, this study provided an unusual opportunity to evaluate young, healthy, active adults who received relatively high NSAID doses (mean, 1.6 DDDs per prescription). No significant elevation in risk was observed among soldiers prescribed between 1 and 7 DDDs of NSAIDs per month.”

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  1. Larry
    North Carolina

    It would be helpful if you would explain what “1.6 DDDs per prescription” measures.

    • Terry Graedon

      A DDD is a “defined daily dose.” The definition is provided by the World Health Organization for the purposes of epidemiological research. WHO offers this definition: “The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.”
      Want more? Here is the url: https://www.whocc.no/ddd/definition_and_general_considera/

  2. Betty
    Wa state

    Define DDD for your lay audience, please.

    • Terry Graedon

      Here is the definition of defined daily dose. It comes from the World Health Organization: “The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.”

  3. Gary

    Back in 2008 I was prescribed celebrex for hip pain until I could get scheduled for hip replacement surgery. As the result of the celebrex I experienced kidney problems: With fasting and cranberry juice I was able to resolve the kidney problems; however, it took about four months to do so.

    In addition to the kidney problems from celebrex I also developed A-fib. I do not know which is worse opioids or NSAIDs.

  4. Suzanne
    Byron, GA

    What about aspirin? This is not listed in your list of NSAIDs. Is aspirin also hard on the kidneys?

  5. Jane Thompson

    What is considered “high dosage”?

    I am 93 years old. In your opinion would two Advil (or similar) for arthritis, be a risk to my kidneys?

  6. Mary Rich
    asheboro nc

    I took Advil / aspirin for years for chronic pain but at what cost. Now I have chronic kidney disease.

  7. Mary rich

    I took Advil / aspirin for years for chronic pain. It kept me going but at what cost. Now I have chronic kidney disease and the doctor said I could NEVER take either one again.
    Now I take Tylenol which is bad for the liver. But when you find yourself between a rock and a hard place, what do you do? Tylenol does not take pain away but just dulls it somewhat.

  8. Pauline
    Upstate NY

    The problem with collecting data from medical records is that only prescribed NSAIDS were included. Not included were any OTC NSAIDS that the same cohort may have taken during the same period, There are no controls that limit OTC use, and it doesn’t take rocket science to figure out how many OTC tablets it takes to equal a high-dose prescribed tablet. Military personnel tend to be careful about how much information they divulge to care givers, especially if they are career oriented.

  9. Richard Nola
    New York

    I take 2 220 mg naproxen a day, is that a high dosage, I am 87.

  10. Eleanor

    My unstable blood pressure problem seems to have been fixed by taking a clove of raw garlic with my evening meal…

    • Ed

      And this has to do with NSAIDS???

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