NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical in your body's production of prostaglandins. It is prostaglandins that cause swelling and pain in a condition such as arthritis or bursitis. Therefore by interfering with cyclooxygenase, you decrease the production of prostaglandins, and decrease pain and swelling associated with this condition.
Common NSAID's would be Celebrex, Vioxx, Bextra, Ibuprofin, Naprosyn & Motrin. The first 3 are what we call Cox-2 inhibitors while the last 3 work against both Cox-1 & Cox-2. The difference between the 2 is that Cox-1 is important in the production of protective lining of the gastric mucosa so obviously extended use of them could cause problems such as ulcers and is a prime reason you are directed to take food with them. The Cox-2 inhibitors are believed to be less of a risk to the stomach lining and therefore are believed to be less capable of producing ulcers. The dilemma is that while Cox-2 inhibitors are believed to have fewer side effects they are not believed to be any better at treating the pain caused by the inflammation.
My take on most of these as well as most medicines is that it is all up to the doctor and the way they wish to treat you. Since the side effects of either of the Cox inhibitors is no better then the other isn't there a better way to treat patients? Do the NSAID's really work so well that we are not willing to abandon them in search of newer and better products?
The recent issues surrounding both Vioxx and Celebrex are a prime example of what I am talking about. Both have been linked to the increased risk of heart attacks as have several other Cox-2 inhibitors Prompting the FDA to step in and take measures urging healthcare professionals to limit the use of some of these NSAID's especially when it is shown that the patient is not responding to the medication or there are other alternatives to pain management.
The problem is that doctors seem more willing to prescribe something that will cause you heart, stomach and liver problems then they are willing to prescribe you narcotics for pain management. They would rather have you develop a lifelong ailment or suffer a stroke or heart attack then allow you to have the pain relief you deserve.
If a doctor is going to prescribe something like NSAID's long enough to develop such serious complications would opioids not be a better choice? It is proven that the addiction factor of these medications is extremely low.
Pain management with opioids
Will I get addicted to opioids if I take them?Many people are afraid that if they take an opioid they will get addicted. Addiction means that you do one or more of the following:
- You have little or no control over how much of the opioid you are using.
- You keep using the opioid even though you do not want or need it.
- You keep using the opioid even though it harms you.
- You crave the opioid.
The number of people who become addicted is extremely small. Opioids should only be taken for the time that they are needed. The amount of opioid that you take should naturally and slowly decrease as the pain goes away. Pain rarely stops suddenly. Pain usually eases over days, weeks, and even months. As your pain decreases, the amount of opioid you take will decrease, too.
Will I become dependent on opioids?
If you are taking the same amount of opioids for two weeks or longer, you will become dependent on them. Dependence is not a problem as long as you need the opioid for your pain. You will need enough of the opioid so you do not run out. Dependence means that your body will become tolerant (TALL-er-ant) of opioids and you may have withdrawal (with-DRAW-ull) if you stop taking them suddenly.
Obviously before jumping in to the extreme end of the opioiods like Oxy and MS Contin the healthcare provider should seek alternative methods such as acupuncture, chiropractors and other non medication therapies. While I do not subscribe to any of the above I do believe that a holistic approach should be taken when working with patients.
Many factors can have an effect on a physical pain and someone dealing with chronic pain is going to most likely be suffering from other issues like depression. Through treatment of those symptoms sometimes the pain level can be brought in to the manageable with medication range or at least down low enough that medication is only needed every so often. This was the case for me right after being diagnosed. I obviously had to deal with the news that this is a permanent injury and it was going to cost me my job. My pain level skyrocketed and I was unable to function without some form of pain meds. My doctor prescribed a SSRI, Lexapro, and within 2 weeks my pain level was back to a level where I was ok for days without other meds.
As the scar tissue grew for me the pain increased and we had to relook at pain management and adjust medications accordingly. We started light, darvocet in conjunction with NSAID's and an SSRI. We constantly review my progress and adjust as needed by adding/removing meds.
In the end I would say NSAID's certainly have a role in pain management but only in a short term role. The benefit of the drugs do not outweigh the side effects and it is proven that there are more effective methods in dealing with the pain. That brings me back to the healthcare professionals who are over prescribing NSAID's in my opinion out of fear of patient addiction to pain medications and the possible back lash that an addiction might bring.
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