When you have muscular, joint aches and pains from over-exercising, over-exerting around the house or in your job, you probably have an over-the-counter NSAID (nonsteroidal anti-flammatory drug) in your medicine chest that you turn to for pain relief. However, more and more, research about these types of pain relievers is raising the red flag about their safety, particularly where your heart is concerned. Let me explain.
What Are NSAIDs?
Nonsteroidal anti-inflammatory drugs include aspirin, COX-2 inhibitors like Celebrex (celecoxib), Motrin, Advil (ibuprofen),Voltaren and Cataflam (diclofenac) and Aleve (naproxen).
NSAIDs come in either prescription strength, such as the controversial Vioxx (rofecoxib, taken off the market in 2004), and Celebrex (celecoxib), to name a few, and over-the-counter NSAIDs such as Advil, Motrin, Aleve, Voltaren and Cataflam.
NSAIDs relieve pain by their anti-inflammatory action.
What Is The Risk of NSAIDs?
Several years ago, Vioxx was found to be onboard in a high number of patients who had had fatal heart attacks and strokes that resulted in the drug being taken off the market. However, there was a question as to whether the presence of Vioxx was the direct cause of the heart attacks/strokes or whether it aggravated an already underlying condition?
Regardless, the American Heart Association, as well as the U.S. Food and Drug Administration, went on to warn that over-use of all NSAID drugs may increase your risk of heart attack and/or stroke. Over-use is deemed to be more than 1200 mg a day.
Subsequently, however, recent Danish and Swiss studies seem to have answered the question about the risk of using NSAIDs to even previously healthy people with no history of heart disease or stroke risk. Results from both studies showed diclofenac and ibuprofen users had 2-4 fold increased risk of heart attack and stroke. Aspirin, also a NSAID, was not part of these studies and, in low doses (less than 325 mg), has always been associated with a lower risk of heart disease.
The heart/stroke risk of NSAIDs comes from the fact that these pain relievers also raise blood pressure and can have an artery-blocking effect forming thrombus, or blood clots, which can break off and cause heart attack or stroke. Additionally, NSAIDs can contribute to excessive bleeding which has been a known side effect of the drugs.
Certain other NSAIDs, however, Aleve (naproxen) and Celebrex (celecoxib), did not appear to raise the risk of heart disease and/or stroke, the studies shown.
What You Can Do
The warnings about NSAIDs are often directed to people who are engaged in a lot of physical activity, namely sports or other exertive activities, or those with arthritis, because they are the group of people who frequently turn to NSAIDs for daily relief of pain. If you want to continue taking an over-the-counter NSAID, here is what I recommend:
- Limit your use to 600-800 mg a day. Although the current limit of safety on ibuprofen (Advil, Motrin) NSAIDS is 1200 mg a day, to be safer, I would cut that dosage in half to 600 mg and not more than 800 mg a day.
- Try naproxen (Aleve) or aspirin. Naproxen is longer-acting and results in taking fewer pills. Aspirin (enteric coated, if your doctor okays), low dose 81 mg (try children’s formula). Take with food to prevent stomach irritation.
- Limit use to 1-2 weeks. If you feel you need more, talk to your doctor about alternatives.
Try Natural Pain Relief First
I always advise my patients to try some natural methods of pain relief before turning to over-the-counter, or prescription, pain relievers. Here are some suggestions that may work for you:
- Warm Epsom salt bath: Contains magnesium which relaxes muscles and is a natural anti-inflammatory.
- Traumeel: A natural, homeopathic, over-the-counter anti-inflammatory pain reliever made from herbs and Arnica. Make sure you are not allergic to any of the herbs in Traumeel before using. Comes in tablets or cream, rub-on form.
- Arnica: Homeopathic anti-inflammatory. Comes in “pellets” or in muscle/joint cream rubs. Sold at health food stores and many commercial pharmacies now carry the creams.
- Boswellia serrata: Used in Indian Ayurvedic medicine for years, studies have shown that Boswellia performs as well as conventional COX-2 NSAIDs, albeit less quickly, without the risk of stomach irritation. It is an anti-inflammatory, anti-arthritic, analgesic.
- Bromelain: A natural enzyme from pineapples, long used for its anti-inflammatory properties and reduced swelling qualities. Try for arthritis and other joint (knees, elbows) pain. Take separate from zinc-containing supplements as zinc inhibits its activity.
- White Willow Bark: Herbal, contains salicin, the same ingredient in commercial aspirin, but is longer acting. If you can take aspirin, you can take White Willow Bark.
As I advise my patients, occasional use of NSAIDs can be helpful short-term. However, daily, continuous usage can elevate your risk of heart disease and stroke. Please try some of the natural pain relief methods here before turning to commercial NSAIDs. If you find you need stronger pain relief, contact your doctor to evaluate your ongoing condition and pain issues.
Mark Rosenberg, M.D.
Common Pain Reliever, http://www.usatoday.com/news/health/2010-06-11-nsaids-heart_N.htm
NSAIDs Increase Risk of Heart Problems and Stroke, http://www.arthritistoday.org/news/nsaids-heart-attack-stroke-risk114.php
Natural Anti-Inflammatories, http://www.massagetoday.com/mpacms/mt/article.php?id=10369