Archive for July, 2015

Try all your pain relief options before reaching for ibuprofen

Friday, July 31st, 2015

FDA recall

I try to avoid fear mongering on my posts but I have been feeling a growing moral pressure to tell the new ibuprofen story for some time.  After reading how long term higher dose ibuprofen use can have the same heart attack or stroke risk as Vioxx, the time felt right to update you all on the issue.  Vioxx was banned by the FDA as unsafe. (The Lancet 2013 382:9894;746-8)

Ibuprofen (aka Advil©, Motrin© etc.) seems harmless enough.  Maybe you’ve worked out too hard, maybe you have arthritis, maybe bad period pains.  For many mild pain patients, this pill can be quite a satisfactory pain management tool. I have taken it myself occasionally.  It certainly is more forgiving than acetaminophen (Tylenol© and other brand names), where even one or 2 pills past the regular dose can land you in hospital with liver damage.

However what I see in my clinic is that people keep taking it.  They come to rely on it.  Some athletes and military personnel even call their daily dose of ibuprofen “Vitamin I”.  And like many chronic self-medicating patients, over time the dosage and the risks go up as the benefits diminish.  I see multi-year users describing how the pain goes down just a couple points, say from a 6/10 to a 4/10 yet when they started the drug totally eliminated the pain. So now they have all this risk just for a minor nudge of pain levels.  Not worth it.

They masked the pain and prevented themselves from learning about the cause and effect their choices had on their body.  If you can learn where cause and effect impact your life, your quality of life will blossom in many profound ways.

Basic common sense suggests that it is better to understand and change the root cause of the pain rather than trying to suppress it once injury occurs.  Working with a professional such as myself will allow you to identify why you have that inflammation so often – and no its probably not aging!  I discuss everything with patients from shoe choices to making sure you vary your workout routine based on your body type.  The treatments I offer can eliminate the need for the drugs completely and can even help with issues like weight loss.

Take the example of arthritis.  I will post more about arthritis later, but a sneak preview here is the fact that the bone changes themselves do not cause the pain directly.  Arthritis pain is now understood to be very complex, and involves changes to the immune and nervous systems.  Note that many people with the bone changes do not have any pain at all!  You cannot predict pain levels just from looking at an x-ray.  Obesity is ofetn the difference between pain or no pain.  Seeing me to kick the ibuprofen habit for osteo-arthritis allows you attack the reasons for the pain in a safe, controlled manner.

So what are the risks with ibuprofen?

Well for example, a dose of hard exercise normally causes minor intestinal tears in healthy people.  These tears usually heal up just fine.  But the ibuprofen makes them worse and can can even slow the repair, so over weeks and months you are causing quite a bit of damage.  Beyond the digestive damage directly, weakening the lining of the gut causes all kinds of other inflammation such as in joints or the heart, or blood vessels – especially those in the brain. (from “Medicine & Science in Sports and Exercise” December 2012 44:12; 2257-62).

The Physician’s Desk Reference 2015 lists several other issues.  Cardiovascular risk including stroke and heart attack.  Renal papillary necrosis (the tissue has died) and other renal injury leading to possible kidney failure, liver failure, blood pathologies.  All noted that risk increases with duration of use.

All of this risk is really quite unnecessary.  Call me, call your PT DC DO LMT etc. etc. and start living pain free without damaging your health.

I found this chart on Pinterest.  It is not complete, e.g. does not have the cautions about using if you are diabetic or asthmatic,  but I hope you find it informative.  (You have to click on it to see the detail…)

NSAID risk