judy foreman

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It’s Not An Opioid, So This Painkiller Is Safe, Right? Not Quite

(ParentingPatch/Wikimedia Commons)

(ParentingPatch/Wikimedia Commons)

By Judy Foreman
Guest contributor

So there I was at midnight, night after night, my neck pain screeching at a 10+++ on a scale of 10, popping ibuprofen by the handful, dutifully worrying about the well-known dangers of a painkiller-induced stomach bleed, but reassuring myself, “At least these pills are safe – not like opioids, the really dangerous stuff.”

Oops. Not quite right. It turns out that I, like many other people with chronic pain, had gotten my worries somewhat backwards: being overly fearful of opioids, which, of course, do have considerable risks, but not worried enough about NSAIDS — non-steroidal anti-inflammatory drugs — such as ibuprofen, Advil, Motrin, Nuprin, Aleve and others.

My mixed-up worries came straight from newspaper headlines, which play up the dangers of opioids (narcotics), and less frequently note the growing evidence for the risks of NSAIDS as well.

But a major new study in the medical journal The Lancet is helping set things straight. In it, British researchers pooled data from an impressive 639 randomized studies involving more than 300,000 patients, comparing various types of NSAIDS to each other and to placebo.

They found that both so-called “coxibs” (anti-inflammatory drugs such as Celebrex) and high doses of traditional NSAIDS such as ibuprofen raise by about one-third the risk of major “vascular events” such as non-fatal heart attacks, strokes and death. These newly-appreciated risks are in addition to the well-documented risks of gastrointestinal bleeding long linked to NSAIDS.

Put differently, the researchers found that for every 1,000 people with a moderate risk of heart disease taking high doses of the NSAIDs ibuprofen (2400 milligrams daily) or diclofenac (150 milligrams daily), about three would suffer a preventable heart attack, one of which would be fatal.

For unclear reasons, Naproxen (Aleve) seems to carry much less risk, a finding that has shown up in a number of previous studies as well.

This is serious, of course, especially for older people who tend to have more cardiac risks as well as more pain. Continue reading

Columnist Judy Foreman On Rampant Under-Treatment Of Pain

Health columnist Judy Foreman

Judy Foreman, perhaps the best-known health reporter in Boston and a nationally syndicated columnist, is now in pain. That is, she is writing a book about chronic pain — titled “A Nation in Pain: Healing Our Biggest Health Problem” –and is deeply immersed in the subject. She has kindly agreed to drop us an occasional post about the world of pain, and here is her first:

There’s a dynamite piece in the Jan. 19 New England Journal of Medicine that I would urge anybody in chronic, severe pain to read.

It’s written by Dr. Philip Pizzo and Noreen Clark, who chaired the committee of pain specialists who wrote an important report last June for the Institute of Medicine, an arm of the National Academy of Sciences. Pizzo is dean of the Stanford University School of Medicine and Clark is director of the Center for Managing Chronic Disease at the University of Michigan.

 

Medical schools barely teach about pain, even though pain is the main reason people go to doctors.

 


In their New England Journal piece, and in the lengthy Institute of Medicine report itself, Pizzo and Clark argue eloquently that under-treatment of chronic pain is rampant in this country, that we have a “moral imperative” to do better and that many patients in severe pain understandably see their doctors as “poor listeners.” (I can vouch for this personally: The first doctor I saw during an 8-month bout of severe neck pain a few years ago suggested my pain was an emotional problem.)

As Pizzo and Clark say, “the magnitude of pain in the United States is astounding.” Continue reading