NSAIDs and Heart Risk
In last month’s medical news, a lead story was the FDA’s strengthening of the language on the increased risk of heart-attack and stroke caused by a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDS) which are often used to treat pain and inflammation.
NSAIDS are used by millions of Americans and include over-the-counter medications such as ibuprofen (Advil, Motrin) and naproxen (Aleve, EC Naprosyn) and other NSAIDS that require prescriptions such as diclofenac (Cataflam, Voltaren) and ketorolac (Toradol). Outlets such as NPR and the Times gave the story wide coverage and it has led many of my patients to ask whether it is safe for them to continue.
I tell them that the knowledge that common pharmaceutical pain treatments can cause catastrophic side effects is well known to the medical profession.
(From the days of medical school, future physicians are expected to know that Tylenol can increase the risk of liver failure; that NSAIDS can increase the risk of kidney injury and gastrointestinal bleeding, not to mention heart attack and stroke; and that opioids can cause respiratory depression and addiction issues.)
But I also remind them that undertreated pain can lead to decreased function, worsened quality of life, and suffering, which is why the pain relief conferred from a medication is always weighed against its side effect profile and the patient’s individual risk profile.
This balance is a central consideration for physicians and patients. By emphasizing the risks of NSAIDS, the FDA is heightening patient awareness and the effect I have noticed so far is a good one, creating a starting point for patients to address their concerns about the safety of NSAIDs.
Some of these conversations have lead some of my patients to stop taking NSAIDS, realizing that the mild severity of their pain or the limited extent of pain relief achieved were not worth the potential for side-effects.
Other patients continue to use NSAIDS with a greater appreciation of their potential harm. As one patient described, ibuprofen decreased her low back pain levels from an unbearable 9 to a 4 four several hours at a time. “I can live with an increased risk of a heart attack,” she said, “but I wouldn’t want to live if I was in nine out of ten pain all the time.”