The painful pain relief confusion

Editor's note: This column was originally published Jan. 27, 2005.

Interesting, isn't it, how our "drug of choice" changes with the years.

These days (if you are of a "certain age") we are more concerned about medicating our aches and pains than ... say ... birth control.

With all of the recent controversy over Vioxx and other "Cox 2 Inhibitors," the choices for pain relief have just gotten smaller.

Those "super-aspirins" were considered a boon for any sufferer of chronic pain conditions because they had the benefit of taking care of pain without causing major upset to the tummy. This was the big problem with over-the-counter non-steroidal anti-inflammatory (NSAID) drugs like aspirin, ibuprofen and naproxen.

But when a study showed that the risk of cardiovascular events doubled in patients taking Vioxx for more than 18 months, it and other similar drugs came under a cloud of suspicion and physicians were warned to limit their use.

Where does that leave those riding the pain train?

Maybe it is time to revisit the local drugstore counter.

According to experts, the Cox-2 drugs' only real advantage over ibuprofen or naproxen is less stomach trouble. Both can be equally effective against pain and inflammation.

But not so fast. Even naproxen was recently red-flagged for the possibility of increasing cardiovascular risk. It seems to come down to a tradeoff between a medicine that helps in the here and now versus a possible increase in risk of a disease in the future.

Pain is painful enough, why does the relief of it have to be so painfully confusing?

Time to revisit the lowly aspirin. It has been around for more than 100 years providing reliable and cheap relief from pain.

In recent years, aspirin's star has risen considerably due to its ability to reduce blood clotting and the resulting benefits for our cardiovascular health. A daily low-dose aspirin regimen (81 milligrams, or a "baby aspirin"), has been shown to reduce the risk of first heart attack in middle aged men by 44 percent. And a new study found that aspirin (and other NSAIDs) helps men survive prostate cancer. But the ubiquitous, miraculous aspirin isn't for everyone.

Recently reported studies have shown that up to 30 percent of people don't derive these heart-protective benefits. Furthermore, combining aspirin with other popular pain relievers such as Advil or Aleve can interfere with the anti-clotting perks of aspirin and increase stomach problems.

For those many who are vulnerable to GI complications and taking an NSAID, physicians often consider adding a prescription level dose of an H2 blocker, such as Zantac, or even an over-the-counter proton-pump inhibitor, such as Prilosec, to protect the stomach.

And then there is Tylenol (acetaminophen).

Most doctors will chose this as the first line of defense against pain because it is relatively low risk and does not anger the stomach. But it is not without its limitations. First of all, it isn't an anti-inflammatory, so it doesn't address pain that is "inflamed." People who drink alcohol regularly are cautioned to avoid taking Tylenol. High doses of the medication can cause liver damage and hepatitis.

So let's review. Cox-2 Inhibitors are bad for the heart. NSAIDs are bad for the stomach. Tylenol is bad for neither but can cause liver complications when abused.

There are a whopping 30 million Americans who daily make an NSAID their drug of choice. That number is bound to increase with the recent FDA advisory to limit Cox-2 prescriptions.

With so many questions afoot, it is probably time to call your physician and pose one of your own: What's up, doc?

Dr. Michael O.L. Seabaugh, a Cape Girardeau native, is a clinical psychologist who lives and works in Santa Barbara, Calif. Contact him at mseabaugh@semissourian.com For more on the topics covered in Healthspan, visit his Web site: www.HealthspanWeb.com.