As if we needed yet another reason to just say no to NSAIDs and opioids, it seems that some of them just aren’t working. So while you may be getting a lot with these drugs—the risk of sudden-death heart attacks and strokes and GI bleeding with NSAIDS, and addiction and more pain with opioids, for starters—there is one thing you may not be getting in return: pain relief.
Before we review today’s supporting literature, let’s review NSAIDs and opioids and why these are such bad-news drugs.
Some NSAIDs, such as meloxicam (Mobic) and celecoxib (Celebrex) require a prescription, but the ones you are probably more familiar with are those you can buy right off your drug-store shelf: ibuprofen, Advil, Motrin, naproxen, Aleve and so on. Whether off the shelf or behind the pharmacist’s counter, all NSAIDs increase your risks of serious side effects. The thing that sets NSAIDs apart from just a normal pain reliever, such as acetaminophen, is that is also tackles inflammation; however, if your inflammation is acute and not chronic, the inflammation is the body’s natural reaction to attempt to heal itself, so it’s not typically a good idea to stop that process with NSAIDs.
The list of NSAID side effects is long and just keeps growing. The links between NSAIDs and heart failure are numerous. One recent study showed an increase in heart-failure hospital admissions when the patients are taking NSAIDs. Another one showed that within five years of a heart attack, NSAID use increased the risk of another heart attack. There is also the disturbing conclusion showing that depending on the NSAID, heart-attack death is increased by up to 407%. And we now know heart-attack risk isn’t just limited to long-term use of NSAIDs; just one week of NSAID use can increase the risk of a heart attack by 50%!
Check out these other risks of NSAID use as well:
Opioids are prescription narcotic pain relievers, such as Percocet, Lorcet, morphine, hydrocodone, and Demerol. The CDC has reported that there is an epidemic of opioid overdose in the U.S., and while that includes illegal opioids, such as heroin, they report that nearly half of these overdoses are due to prescription opioids. So the risk of addiction and overdose is certainly a strong reason to say not to opioids.
More reasons? Not only are certain opioids not relieving pain, we also know these narcotics can actually amplify pain by indirectly creating inflammation in the spinal cord, leading to chronic pain. So opioids can actually cause more pain in the long run than the pain they are supposed to prevent. Similarly, if you are considering a knee replacement and you’ve taken even just a single prescription of opioids within two years prior to your surgery, you are at a higher risk for increased pain after surgery.
The new study out of Australia set out to research why certain pain medications may not work for everyone. When we encounter a painful stimulus, a paper cut for example, protein receptors on our cell surfaces send the signal to our brain that we are in pain. Pain medications can block these signals from the cell surface. The study focused on a specific protein receptor called NK1R that is stimulated by pain. However, they discovered that NK1R is sly—when pain activates it, it slips inside the cell membrane, effectively shielding itself from the effects of pain medication (which can’t penetrate the cell surface). The protein, therefore, is able to continue signaling pain.
The upshot? If your pain medicine doesn’t seem to be working, that sneaky NK1R protein may be the reason, and the risks certainly aren’t worth it when your pain medicine isn’t actually working. After additional studies, researchers are hoping to use these results to create more-effective pain medications that don’t carry the dangerous risks of NSAIDs and opioids, so we’ll follow this if it happens.
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About the Author
Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…