Many of our patients at Kettering Osteopaths are people who say “they don’t like to take tablets if they can avoid it”. The recent media reports about the risks of painkillers causing possible heart attacks has prompted some patients to question whether they should reconsider taking the tablets prescribed for their pain.
Some types of pain can be helped with other approaches. For example osteopathy and massage therapy may help musculoskeletal problems that are causing pain, and ‘talking’ therapies such as hypnotherapy may help patients to cope better with chronic pain. Other philosophies such as acupuncture may also help to manage the pain without the use of pain killing drugs.
A recent study carried out by researchers from the University of Oxford and funded by the UK Medical Research Council and the British Heart Foundation stated that there was a small but statistically significant risk that high doses of non-steroidal anti-inflammatory drugs (NSAIDs) increased the risk of serious conditions such as heart attacks.This story was widely reported in the UK media recent, and the quality of the reporting was generally of a high standard. Unlike in previous ‘drug-scare’ stories most media sources put the individual risk in its proper context, explaining that it is very small.
If a patient is unwilling or unable to take NSAIDs (non-steroidal anti- inflammatory drugs), then paracetamol is usually a safe and effective alternative, unless there is a history of liver problems. Doctors may also prescribe muscle relaxing drugs such as amitryptaline or diazepam. Doctors or pharmacists can provide patients with information to allow an informed choice and can help patients to weigh the benefits of these painkillers against this small risk of a serious side effect. The risk of gastro-intestinal (stomach) irritation is a much more likely side-effect than a cardio-vascular (heart) problem for most patients, and many GPs will prescribe a stomach-protecting drug such as omiprazol if this is the case.
NSAIDs, such as ibuprofen, diclofenac, naproxen and coxibs, are widely used to relieve pain and inflammation. Many patients take such medication to help control their musculoskeletal skeletal pain, (such as back pain and arthritis.) The doses sold in ‘over the counter’ packets tend to be of a smaller dose than those in the study. It is thought that people taking long term NSAIDs in larger doses than most self- prescribers have an increased risk of serious heart conditions compared with those who just take an occasional low-dose ibuprofen pill for a headache or back pain. The actual risk to individuals is very small. For example, this study found that for every 1,000 patients taking a high dose of NSAIDs for a year, three more had a major vascular event, one of which was fatal, when compared with placebo. It is almost universally accepted that most treatment comes with both benefits and risks, so patients need to be assured whether the benefits of their medication outweighs the risk of heart attack that may exist if they are taking high doses of NSAIDs over a long period.This new review of hundreds of studies found that coxibs and diclofenac increased the risk of major vascular events – mainly heart attacks – by a third, while ibuprofen was also associated with a greater risk of heart attack. High-dose naproxen did not affect the risk of heart attack, and most people ( who take low doses for a short period of time) are not at any significantly increased risk of heart attack at all as they are simply not taking the doses referred to in the study.