The People's Perspective on Medicine

Show 1005: Balancing Benefit & Risk for Pain Relief

Balancing benefit & risk of medications to ease pain can be tricky; what other options do people have?
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Balancing Benefit & Risk for Pain Relief

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Millions of Americans rely on popular pain relievers such as celecoxib, diclofenac, ibuprofen, meloxicam, naproxen and other NSAIDs (nonsteroidal anti-inflammatory drugs). The fact that some of these medications are available without prescription in products such as Advil, Aleve or Motrin IB gives many of us the impression that they must be safe.

Balancing Benefit & Risk of Pain Relievers:

This summer the FDA beefed up its warning that NSAID use can increase the chance of suffering a heart attack or a stroke. The risk begins to increase within the first few weeks of use and continues to rise the longer someone takes such a drug. Higher doses also appear to be riskier.

These medicines are a mainstay of treatment for such painful conditions as arthritis, bursitis, gout, plantar fasciitis and tendinitis, not to mention back pain. What alternatives do people have to alleviate their pain?

SPRINT Study Stopped Early:

You may have heard the announcement that a large study designed to find out about the benefits of lowering blood pressure in middle-aged and older people was stopped two years before schedule. The scientists running the study found that getting systolic blood pressure below 120 offered so much benefit that it would be unethical to keep the study going. How much do we know about this study? Did the researchers take into account the side effects of multiple blood pressure medication?

We discuss the problems of balancing benefit & risk of medications for pain, the treatment of high blood pressure and the reason you shouldn’t feel bad about leaving your bed unmade. We answer your questions with pharmacologist and health journalist David Kroll.

This Week’s Guest:

David Kroll, PhD, is a pharmacologist and medical writer in the Research Triangle Park area of North Carolina. He has taught at the University of Colorado, Duke University and North Carolina Central University. He now works on educating the public on matters pharmacological through his blogs. The picture is of Dr. Kroll.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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17 years ago I was suffering from neck and shoulder pain. I took some pain meds, but they didn’t do very much. For at least 4 years, I worked as a full time medication RN,now retired.
have seen how the MD’s struggled, with the wishes of the patients en very often caved in and gave them their opiads.

I didn’t want to end up like that. One evening, there was an refreher get together for retired RN’s
One of the speakers was an acupuncturist. She asked us, who was in pain and who was willing to
try the acupuncture.
I stepped forward and had my needle pincushion!
I was used, to take pain pills a couple of times a day. guess what, I forgot about to take any pills! NO PAIN for a whole week!
I have been seeing this wonderful lady ever since.
First, it was once a week and now, I see her only once a month for maintenance.
Of course, no side effects.
It also helps for other ailments, you just have to tell the acupuncturist about it and the needles, will be placed in a different place.
All of us nurses, didn’t believe it at first, but I am so happy, that it works so well for me.
Try to find some body, who went to the Oriental University of medicine. Th acupuncturist is also trained in herbal medicine and allowed to suspend the pills etc. They won’t hurt and work wonders.
Good luck to you all.

Has anyone looked into Kratom? What are the risks if any with its use? I’ve heard it works as good as opiate based meds, but without the addiction or constipation problems.

I wish you had spelled out the synthetic thiamine mentioned in program 1005. Is it possible you get an email response with that?

I am under the care of a heart specialist also with only one kidney functioning I have to be careful what meds I take as my kidney doc says no aleve or anything much, but I had a serious fall and broke a rib and as my head hit rather hard on the floor I had a concussion. and now having severe vertigo .it come with the fall while I was in rehab and left for awhile,now it comes and goes especially when I turn my head to the left. the right side of my head was in the fall as I landed on my right side, I was passed out and come to in the ambulance and since this was three years ago . why do I have this vertigo that goes away for awhile then comes back fiercely, and its very debilitating.

When you hit your head, you probably knocked some crystals loose in your inner ear and they’re causing your vertigo. Find someone who can do the Epley maneuver on you. Some doctors, chiropractors and physical therapists can do this. My husband had this problem and we solved it by learning how to do it ourselves on and it worked for him. We also know other people in our community who have done this. Give it a try.

I’ve been an on/off user of diclofenac and eventually meloxicam. My concern is that there seems to be limited healing with my injury, but temporary pain relief is achieved during use. Surgery seems to be an option. I absolutely hate taking any NSAIDS to treat my pain for I’ve seen first hand with a dear relative how such drugs affect two important systems. She ended up requiring kidney and liver transplant. She being a diabetic took Tylenol on a regular basis for years and developed non fatty liver disease. I wish I knew what came first… Diabetes or the liver disease. She was afflicted with a bleeding ulcer 10 years prior to developing the liver disease. Long story short, she treated Tylenol as if it were completely safe! Now we know the truth. I will attempt to relieve my pain without the meds. But I’m afraid there are few options to treat my knee pain.

I am 61 years of age with arthritis in my feet and back. I would not sleep at night without taking something for pain. Aleve took pretty good care of it, but after hearing how harmful it is to take on a daily basis, I switched to Curcumin. I have to say that it is more effective than Aleve for me. I am fortunate to be able to buy it through our food co-op, which carries a product produced in Green Bay. It is a pretty strong dose, which I believe is necessary to be effective. I highly recommend it.

I am a personal fitness trainer and Reiki Master in Cornelius, NC.
I treat clients every day for pain. Here is what we have found effective:
— foam rolling – natural anti inflammatory
— trigger point therapy– I teach self treatment and gets to the source of the pain
— Reiki treatment — I have observed immediate relief
— Meditation
Thank you for your work, your show and other important communications!


Would you be so kind and elaborate on the treatment you suggest. Iam very curious. I try meditation, Im learning Reiki. What do you mean by foam rolling?.
Thank you so much!

I had an experience long ago that taught me my limits with NSAIDs. About 25 years ago when I was 35-ish and mothering a baby–when Ibuprofen was first available by prescription–I severely sprained my ankle and a very beloved family doc even met me at her office to X-ray and treat it on a Saturday. She prescribed Ibuprofen at about 300 mg every four hours. I awakened that night in agony with stomach pain. My husband hurried to the grocery store and bought milk (we had none on hand, as I was nursing our baby). I drank a small glass of milk then about 2 oz. every 15 minutes until my stomach stopped hurting. It helped, and I have never taken Ibuprofen since.

So now, at age 61 I do have osteoarthritis particularly notable in my knees as well as Tendonopathy (likely from those repeated sprained ankles years ago). My orthopedist is managing my knee pain, and my Podiatrist/Foot and Ankle doc is treating the ankle pain. Both are honoring my desire to avoid surgery for a few years.

I like Dr. Kroll’s suggestion of topical NSAID. That is what I use as well as finding Arnica Gel helpful when I don’t want to “overdo” a 4 gram a day topical dosage.

AND, yes, I take a blood pressure med; a generic metoprolol. The key for me is that it needs to be the generic by the same company that makes Toprol or it doesn’t work. Since ACA, it is clear to me that Pharma is raising its costs of medications.

Finally, My veterinarian spouse has found that he used to be able to prescribe Doxycycline (a long available medication) for a dog for $40.00 for 10 days or so. Now that prescription is hundreds of dollars!

Having had double hip surgeries in 1963 as a twelve year old, I recovered and have lived a very active full life. As an itinerant teacher with instruments to carry into each class, I could not miss for back, knee, foot or excrutiating hip pain in my later teaching years. I switched from ibuprofen after throat /stomach issues to naproxen/Alive probably 25 years ago. I became worried at the volume I was taking…2 am and pm…and retired asap to have multiple orthopedic replacements. Since the surgeries, this dosage was reduced to just one a day until I got concerned.

In the last two years I’ve largely needed naproxen only 1 every other day, some aspirin at night. I use many of your antiinflammatory suggestions…turmeric, krill oil, topical aspercream, ice, heat, gin and raisins, tart cherries, strengthening. Regular exercise helps of course.

I may have missed this bullet.

Thank you

age of 70 years, do not use any pain meds and do not have joint pain. About 20 years ago, I had joint pain that I thought was related to old age. Turned out to be RMSF. After treatment with Doxy there was no longer any pain and still have no pain. I do use fish oil. Four grams a day and one cup of organic tart cherry juice a day.
I had dropped a fifty pound block of salt on my foot and had pain. The fish oil did not help but heard a lady on your program talk about how tart cherry juice stopped her foot pain. Tried it and darn if it didnt stop my foot pain too. So have not stopped taking either of them and get up in the morning pain free.
Funny when I went to the doctor last fall for removal of ear wax, they asked what meds I was on and did not quite believe me when I said none. I was asked by two other office personnel including the doctor before they realized I did not forget or did not know. This is scary as just because you have age on you does not mean you need meds for anything.

What about good old ASA, aspirin? It’s considered a non steroidal pain reliever. I use it for its anti flammatory properties. Does this plant based med. have these same adverse effects?

Aspirin actually protects people against heart attacks and strokes rather than increasing their risk.

What about people on blood thinner, warfarin, and also diltiazem take for pain that would be safe?

The combination of warfarin with an NSAID like ibuprofen is very dangerous. Possibility of bleeding (and bleeding) ulcer.

I found that taking one ibuprofen works just as well as two. If the pain is that bad, I’ll take one, and then take a 500 mg tablet of Tylenol with it. There is no way I would ever take Aleve (naproxen)

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