View Full Version : NSAIDs: Not as Safe as Patients May Think

Sat 17th May '14, 11:43am
Editor's Note:

A survey of over 9000 patients published in 2005 concluded that over-the-counter (OTC) analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), are widely used, frequently by patients who are generally unaware of the potential for dangerous adverse side effects.[1] Given recent concerns about use of acetaminophen products, particularly products with 500 mg or more per tablet,[2] and the potential that patients will turn to NSAIDs as an alternative, it is more important than ever that clinicians provide accurate education about their use. Medscape spoke with Bill H. McCarberg, MD, founder of the Chronic Pain Management Program at Kaiser Permanente in Escondido, California, and a board member of the Alliance for the Rational Use of NSAIDs (http://www.nsaidalliance.com/), about the latest evidence regarding these ubiquitous products.

Safety Issues With NSAIDs Medscape: NSAIDs continue to be a widely used medication, particularly for patients with inflammatory conditions. A 2013 analysis of 7 years of data from the National Ambulatory Care Survey reported that they were used in 95% of the almost 7 million patients in the study sample who used at least 1 chronic pain medication.[3] The next closest agent was only used in one quarter of patients. Are there any data indicating that the concerns about a lack of patient knowledge about safe and appropriate use have changed since the survey published almost a decade ago?

Dr. McCarberg: It's an interesting conundrum. When patients have pain, they may not know what to do about it. They are unwilling to go in to be seen and pay a copay, because that is an increasing financial burden for them. The recent acetaminophen warnings, particularly noting that it is included in multiple different products and that excess doses could cause liver damage, are worrisome. The cardiovascular (CV) and gastrointestinal (GI) risks associated with NSAIDs have been widely reported; renal risk has not received as much attention in the lay press, but must be considered. And of course everybody talks about the opioids, the prescription painkillers, and the overdose deaths that are occurring in the United States. I think patients are confused and concerned about what they should do when they have pain.

The National Ambulatory Care Survey, conducted over a period of 7 years, found that 95% of patients said they took NSAIDs, illuminating just how common the experience of pain is. Although warnings about risk have been widely reported, patients don't necessarily know how hazardous NSAIDs can be; otherwise, there wouldn't be as many people taking them. Yet pain is so common that they have to take something, and they believe this is as safe as anything.

If you had a problem, what would you take? You would probably take an NSAID or acetaminophen, because there's nothing else. What do you take when you have a headache, sprain your ankle, or have a recurrent back problem? Most of us would take something. And if you ask patients whether there is a risk involved, they would answer "yes," but also note that these agents are available OTC and they wouldn't be OTC unless they were safe.

I recently looked into use of NSAIDs by athletes, and the number of high school, college, and professional athletes who use NSAIDs regularly to help with muscle aches and pains from competition is astounding. And potentially hazardous. These agents have never been proven to help with those muscle aches. Gastrointestinal issues can be significant, because you don't necessarily eat before an event. Athletes get dehydrated in an event, and with dehydration, there is more risk to the kidney. Now you put an NSAID on top of that, increasing renal risk. It's interesting that even our healthy athletes are using NSAIDs. There are side effects even in the group that you would think is the healthiest in our society.

So, the reasons that so many people take these drugs are complicated, and it is a function of just how common pain is in our society and confusion on the part of patients who don't know what to take.

Patients are also turning to alternative care -- which we're now calling "integrative care" because we don't think it is alternative treatment but rather more mainstream treatment and includes acupuncture, chiropractic, herbal therapies, yoga, and massage. People are paying out of pocket for these therapies because there is some worry that regular medical care is too expensive, and that OTCs may not be safe.

So back to your original question about patient recognition of risk. Patients may not know the exact risk profiles of NSAIDs, but they know there is some risk. And they don't know what else to do.

Source site: http://www.medscape.com/viewarticle/822725?nlid=53543_1842&src=wnl_edit_medp_wir&spon=17