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Pain Medications and the Risk of GI Complications

Posted Aug 24 2008 1:49pm
ANNOUNCER: Life can be filled with all sorts of aches and pains, which is why over 30 million Americans take medications known as NSAIDs every year.

MEL WILCOX, MD: NSAIDs are non-steroidal, anti-inflammatory drugs, commonly-used pain relievers that you can buy in the drugstore or your physician can give you.

BYRON CRYER, MD: Some of the common over-the-counter brands are things such as ibuprofen or naproxen. They go by trade names such as Aleve, Advil, Motrin. Aspirin is available in various forms, such as Bayer, Excedrin, even baby aspirin is considered an NSAID.

ANNOUNCER: Many of us use these medications as a convenient way to ease pain. However for some people there can be dangerous consequences: problems many of us don't even know exist.

BYRON CRYER, MD: There are over 100,000 hospitalizations per year, thousands of deaths per year attributable to NSAIDs. And the problem is that most people, most consumers are unaware of the problems that exist with NSAIDs.

MEL WILCOX, MD: It's been estimated that over 16,000 people die each year from NSAID-related complications.

GEORGE TRIADAFILOPOULOS, MD: NSAIDs are associated with the possible development of several major gastrointestinal complications, specifically bleeding from the stomach or anywhere from the gastrointestinal tract, development of what we call perforation, which is basically a hole in the stomach.

ANNOUNCER: While problems may not always be severe they can be troublesome

GEORGE TRIADAFILOPOULOS, MD: Most frequently cause indigestion kind of symptoms which are obviously a nuisance for the individual patient using these drugs

ANNOUNCER: Interestingly enough what makes NSAIDs work as pain relievers contributes to the problems they may cause.

BYRON CRYER, MD: Through the same mechanism by which they are effective as pain relievers, they inhibit an enzyme which reduces inflammation in your joints. But they inhibit the same enzyme in the stomach that protects against ulcers. And so when you take the NSAID, with the goal of reducing inflammation in your joints, it has to see the stomach first. And it has the consequence of reducing the protection in your stomach.

ANNOUNCER: Although everyone can be at risk for NSAID-related problems, not everyone will develop complications. There are certain factors that place people at higher risk. Advanced age is one of those.

GEORGE TRIADAFILOPOULOS, MD: It is more likely to develop the problem with these drugs if you're older, particularly older than 65 or 70 years of age.

ANNOUNCER: Certain medical conditions can leave a patient open to complications.

MEL WILCOX, MD: People who have a prior history of an ulcer are more likely to have a problem. People who have a prior history of bleeding from the GI tract would have a problem

ANNOUNCER: Problems also may result because a patient is unknowingly taking too many NSAIDs as in the case of using NSAIDs along with aspirin, which is also an NSAID.

MEL WILCOX, MD: There are a variety of aspirin-containing medications you buy in the drug store from cough syrups to a variety of medications. So you really need to read the labels to make sure you're not taking an NSAID in addition to the NSAID that the doctor is giving you.

ANNOUNCER: Combining other medications with the use of NSAIDs may also cause difficulties.

GEORGE TRIADAFILOPOULOS, MD: Another category of drugs are the blood thinners, so-called Warfarin and other compounds. And finally, another class of drugs are the corticosteroids which are drugs that are used for the management of arthritis.

ANNOUNCER: Overusage can also contribute to the problem.

MEL WILCOX, MD: You can take too many of them because you have persistent discomfort and you take a dose too early, or you increase the dose yourself because of discomfort.

ANNOUNCER: Lessening the likelihood of NSAID-related problems means being aware of the potential difficulties and communicating with healthcare professionals

BYRON CRYER, MD: Because of the various conditions and risk factors that are associated with NSAID use, there is always the potential for being at risk and not being aware that that risk exists.

And so it's important to have conversations with physicians, with pharmacists; to read labels; to have discussions with healthcare providers about whether you might be at risk if you're taking an NSAID-type medication.

ANNOUNCER: Keeping your doctors informed means letting them know about any medication you take, even those you get without a prescription.

MEL WILCOX, MD: The problem is patients believe that if you buy a medication at a drug store, it's safe. So when your doctor asks you what medications you take, you only tell them about the prescription medications, not the ones you buy in the drug store.

ANNOUNCER: Other medications can also be used to protect against NSAID- related problems.

BYRON CRYER, MD: There are other medicines, ulcer medicines that can be taken to reduce the risk. These are medicines which reduce your stomach acid.

GEORGE TRIADAFILOPOULOS, MD: There are also drugs today that are generally considered safer than the traditional non-steroidal agents. And therefore, we have ways of adjusting our treatments according to the risk.

ANNOUNCER: While NSAIDs are an easy way to get quick relief, taking them carries the responsibility to be informed.

MEL WILCOX, MD: The main way you can really reduce your risk factors is to understand what the risk factors are. Probably the most important way to reduce your risk is really to understand the medications that you're taking, and by doing that, you would know that if you're on one of these medications that can increase your risk, that's probably the most important thing.

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