NSAIDs (nonsteroidal anti-inflammatory drugs) are best sellers in the pharmacy. According to our calculations, over 10 million people take prescription-strength celecoxib, diclofenac or meloxicam. We estimate that another 14 million take prescription-strength ibuprofen or naproxen. That doesn’t take into account the millions more who swallow OTC ibuprofen or naproxen as their joint pain solutions. However, there is a downside to these NSAIDs, as this reader discovered.
Meloxicam Caused Real Pain:
Q. I took meloxicam to treat arthritis pain for a year. Then I was rushed to the E.R. with excruciating pain in my abdomen. After many x-rays, the doctors determined that I had a ruptured peptic ulcer and needed emergency surgery.
They told me to stop taking meloxicam immediately to avoid a repeat. I certainly don’t want another ulcer, but I would like some relief for the joint pain. What can you suggest?
A. NSAIDs like celecoxib, diclofenac, ibuprofen, meloxicam or naproxen can all increase the risk for ulcer formation. A ruptured peptic ulcer (also called a perforated or bleeding ulcer) is a life-threatening condition, as you discovered.
Other Readers Share the Pain:
Paula also had to have emergency surgery:
“I had emergency surgery for a perforated stomach ulcer after taking 600 milligrams of ibuprofen 3 times a day per doctor’s instructions for sciatic nerve pain. I took it with protein as directed.”
Susan warns about dosing with ibuprofen:
“My husband hurt his shoulder trying to get rid of a beaver dam. He used ibuprofen, thinking it was a safe pain medication even at unrecommended doses. Long story short, he ended up being hospitalized and almost died due to hepatic encephalopathy and gastric ulcer.
“The scary truth is ibuprofen is not safe if taken in larger doses, or even every day at recommended doses. My sister had increased liver enzymes from taking doses at recommended levels.”
Jen shared a tragic story about a family member on naproxen:
“In May, an older family member was prescribed prescription-strength naproxen for severe arthritic wrist pain. He was already taking a full strength aspirin due to having stents inserted in coronary arteries. It took just 13 days until he was admitted to the emergency room with ‘massive internal bleeding’ for an ulcer that had developed. His blood pressure was 46/15 and he was unresponsive shortly after arriving.
“He received 5 units of blood that day. Obviously, he nearly died and was hospitalized for 6 days. Then they transferred him to skilled nursing for over 3 weeks. He is frustrated, angry, and depressed, with no control over his life. It is a tragic situation.”
D.L.B. got into trouble with diclofenac:
“I took diclofenac orally for 20+ years for osteoarthritis in my knees along with a PPI prescribed to ‘protect my stomach.’ About a year ago I went to bed on a Friday night and woke up 3 days later in the hospital. I was told I was in septic shock and completely unresponsive when the paramedics were called. Although I spent 12 days in the hospital, the only issue the doctors found was a bleeding ulcer. I no longer take any NSAID orally.”
Other Complications of NSAIDs:
Most people realize that nonsteroidal anti-inflammatory drugs can cause a lot of gastrointestinal nastiness: heartburn, abdominal pain, nausea vomiting and stomach ulcers.
Bleeding or perforated ulcers are not the only serious complications of NSAIDs. Some people are susceptible to dizziness, drowsiness and disorientation. Others develop a skin rash, especially if they go out in the sun.
Then there are cardiovascular complications. Fluid retention and high blood pressure are not uncommon. Worse, there can be heart failure, heart attacks, strokes and irregular heart rhythms (atrial fibrillation).
Let’s not forget hearing problems, including tinnitus (ringing in the ears) or hearing loss. Some people also report visual disturbances. Then there is the possibility of liver and kidney damage.
Of course, many people do seem to tolerate NSAIDs without serious adverse reactions. But it is hard to predict if or when something bad could happen. That is why people need joint pain solutions that don’t involve NSAIDs.
Non-Drug Joint Pain Solutions:
The reader who ended up in the E.R. might want to consider some home or herbal remedies to see if one works. Many people find that gin-soaked golden raisins can help. Others prefer Certo plant pectin dissolved in grape juice. Knox gelatin stirred into juice, yogurt or applesauce also has its fans. On the other hand, there are proponents of honey and vinegar, a very old-fashioned combination.
Honey and Vinegar for Arthritis:
Q. As a pharmacist in New England, I had a customer who was an elderly physician. When he overheard me talking with a client about her arthritis, he interjected politely that none of his patients are bothered with arthritis. Apparently, they take a kitchen remedy of apple cider vinegar and honey.
I told my mother about this because she suffered with arthritic pain. She mixed up a potion of honey and vinegar, using apple cider vinegar, and started taking it. Within three days the pain went away. This works, but it does have a peculiar odor.
A. Apple cider vinegar and honey has long been a favorite New England home remedy. Dr. D. C. Jarvis wrote about it in his best selling book, Folk Medicine: A Vermont Doctor’s Guide to Good Health. He recommended a daily drink of eight ounces of water with two teaspoons of apple cider vinegar and two teaspoons of honey mixed into it. Dr. Jarvis didn’t take credit for the remedy, though. He said he had learned it from his patients.
Honey and Vinegar for Joint Pain:
There is little if any scientific research on the combination of honey and vinegar, although it is part of Chinese medical tradition as well as western folk medicine (Zou, American Journal of Chinese Medicine, 2016). Because vinegar has a reputation for controlling blood sugar, Iranian scientists tested the effects of honey and vinegar together (Derakhshandeh-Rishehri et al, International Journal of Preventive Medicine, Dec. 2014). They found that this combination raised fasting insulin and lowered both total and HDL cholesterol levels. It did not significantly lower triglycerides, LDL cholesterol or fasting blood sugar.
Herbal Joint Pain Solutions:
Herbal therapies including ashwagandha, Boswellia, ginger or stinging nettle may also ease inflammation. Some people find that acupuncture or bee sting therapy can be helpful. Others report good results with the dietary supplements MSM and SAMe.
You can learn more about all of these approaches in our eGuide to Alternatives for Arthritis. This online resource is available in the Health eGuides section of www.PeoplesPharmacy.com.