NSAIDs Are Not So Safe Either

It’s hard to believe that opioid overdose now kills more people than car accidents in the US, but we’ve been told this so often that it must be true. Pressure is building on prescribers to use something else to treat most patients with chronic pain, and in many cases that something else will probably be an NSAID. NSAIDs are not addicting and overdose deaths are not likely to be a problem, but of course they are not entirely safe.

GI ulceration, perforation, and bleeding can occur with all NSAIDs, often without warning. All NSAIDs decrease renal blood flow, cause fluid retention, and may cause hypertension and renal failure, especially in the elderly. Decreased renal function, diuretic therapy, cirrhosis, or heart failure increase the risk of renal toxicity. NSAIDs have been associated with an increased risk of myocardial infarction and stroke. They can cause anaphylactoid reactions (in aspirin-sensitive patients), aseptic meningitis, Stevens-Johnson syndrome, and aplastic anemia.

NSAIDs also can interact adversely with some other commonly used drugs. They can decrease the effectiveness of diuretics, beta-blockers, ACE inhibitors, and some other antihypertensive drugs. They may decrease the clearance and increase the toxicity of lithium and methotrexate. And they may increase the INR in patients taking warfarin.

So maybe opioids won’t be used so much anymore to treat non-cancer chronic pain. But NSAIDs may not offer a safe alternative, especially for elderly patients who are more susceptible to their adverse effects and more likely to be taking the drugs they interact with.

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  1. Daniel McGrath, M.D. says:

    A timely reminder.

  2. James R. Chaillet, Jr., MD says:

    Great post. Adds another thoughtful perspective to the argument of how to treat chronic pain and deal with the drug problem. Added to the problem are studies suggesting that acetaminophen doesn’t work well in treating the pain of osteoarthritis and back pain. I suspect we can look forward to and be on the alert for more GI bleeds and acute renal failure. Oh, the number of drug overdoses may not decrease because heroin is cheap and available.( I’m close to KY)

  3. EarthLink says:

    Very impt message. Neal

    Sent from my iPhone


  4. Just read in the latest issue about a different form of meloxicam that may be a bit better than the current one. But there’s no good solution yet for the problem of chronic pain (joint, osteoarthritis, etc.). Thanks for keeping us abreast.

  5. Fernando R Montoya, MD says:

    Good point on NSAIDS. However, Maybe its time to more aggressively employ non-pharmaceutical methods to treat pain which are more effective than opioids. Physical therapy, Tai chi, yoga that’s modified for patients with severe OA are all as effective in studies and will reduce the amount of any type of medication used.

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