A new study has recently been published that demonstrates an increase in the risk of heart attacks in individuals using NSAIDs on a regular basis.
Concerns had been raised about the risk of heart-related side effects of NSAIDs following randomized trials demonstrating that COX-2 inhibitors (also known as coxibs) could increase the risk of heart attacks. This finding was troubling; particularly as many NSAIDs are used in high doses on a prolonged basis to combat chronic pain, and have been on the market for many years.
Two of the drugs in the international study, diclofenac and ibuprofen, were found to increase the risk of a major vascular event (i.e., stroke, heart attack or dying from cardiovascular disease) by approximately one-third when taken in high doses. On average, the research suggests that these drugs lead to three additional heart attacks in every 1000 patients treated, including one fatal incident.
Colin Baigent, lead scientist of the study from the University of Oxford (Oxford, UK), commented, “We would emphasize that the risks are mainly relevant to people with arthritis who need to take high doses over a long period. A short course of lower dose tablets purchased without a prescription, for example, for a muscle sprain, is not likely to be hazardous.”
Unlike diclofenac and ibuprofen, the study showed that naproxen does not appear to increase the risk of heart attacks. Researchers believe that this is due to the protective effects that this drug has, which are apparently able to counteract any increased risk of heart attacks.
Shannon Amoils, research advisor at the British Heart Foundation, commented, “Based on this research, we would reiterate the advice that people should take the lowest effective dose of these drugs for the shortest time necessary to control symptoms. Although people who take painkillers infrequently needn‘t be overly concerned, those who need regularly prescribed painkillers should speak to their doctor about which drug is the most suitable choice for them.”
Some patients that may need to re-evaluate their medication include arthritis sufferers who regularly take NSAIDs to reduce pain and swelling. Although, Alan Silman, medical director of Arthritis Research UK, points out that a healthy diet, not smoking and having regular blood pressure checks are of greater importance in reducing the risk of heart attack than switching medication. Silman notes, “NSAIDs are a lifeline for many millions of people with arthritis and, when used appropriately, can be extremely effective in relieving pain. We would advise people with arthritis who are taking NSAIDs not to be unduly concerned by these latest findings and to seek the advice of their general practitioner.”
Furthermore, researchers re-analyzed the results of the 639 randomized trials studied, which involved over 300,000 people, to predict the side effects of NSAIDs, in particular, in patient groups. These data will hopefully be a useful aid in the prediction of which patients are at the greatest risk of heart attacks and ulcer bleeding following NSAID treatment.
Baigent concludes, “This new research shows how to calculate the likely size of any risks of NSAIDs for an individual patient, which should help doctors and their patients when they consider the treatment options.”
– Written by Sophie Breeze
Sources: Coxib and traditional NSAID Trialists‘ (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet doi:10.1016/S0140–6736(13)60900-9 (2013) (Epub ahead of print); Clinical Trial Service Unit press release: www.ctsu.ox.ac.uk/news/press-releases-archive/CNT%20300513.pdf
A genetic risk factor for persistent pain following traumatic events has been identified in a new study.
The study, led by researchers from University of North Carolina School of Medicine (NC, USA), has provided evidence that persistent pain following stressful events, such as a sexual assault or motor vehicle collision, is, in part, owing to a specific biological process.
The study looked at how the hypothalamic–pituitary–adrenal axis, which is a system closely linked to how the body responds to stressful events, was able to influence the severity of musculoskeletal pain 6 weeks after sexual assault or motor vehicle collision. In the study, patients involved in a motor vehicle collision who had a variation of a gene that encodes a protein known to regulate the hypothalamic–pituitary–adrenal axis in response to stress (FKBP5) had a 20% higher risk of moderate-to-severe neck pain and greater body pain. Similarly, victims of sexual assault with the same variation also experienced more pain at 6 weeks than those without the variant.
“Our study findings indicate that mechanisms influencing chronic pain development may be related to the stress response, rather than any specific injury caused by the traumatic event,” explained Samuel McLean, assistant professor of anesthesiology at University of North Carolina and senior author of the study. “In other words, our results suggest that in some individuals something goes wrong with the body‘s ‘fight or flight‘ response or the body‘s recovery from this response, and persistent pain results.”
While medications can be given to treat the immediate pain following injury, or to prevent pregnancy or sexually transmitted diseases after a sexual assault, there are no treatments that are able to prevent chronic pain. This is, in part, owing to the fact that the biologic mechanisms behind chronic pain are still not well understood, limiting the available treatment options.
McLean discusses the problems behind treating chronic pain following traumatic events, “Chronic pain after these events is common and can cause great suffering, and there is an urgent need to understand what causes chronic pain so that we can start to develop interventions. This study is an important first step in developing this understanding. In addition, because we don‘t understand what causes these outcomes, individuals with chronic pain after traumatic events are often viewed with suspicion, as if they are making up their symptoms for financial gain or having a psychological reaction. An improved understanding of the biology helps with this stigma.”
– Written by Sophie Breeze
Sources: Bortsov AV, Smith JE, Diatchenko L et al. Polymorphisms in the glucocorticoid receptor co-chaperone FKBP5 predict persistent musculoskeletal pain after traumatic stress exposure. Pain doi:10.1016/j.pain.2013.04.037 (2013) (Epub ahead of print); University of North Carolina Newsroom: http://news.unchealthcare.org/news/2013/may/persistent-pain-after-stressful-events-may-have-a-neurobiological-basis
Researchers from Wake Forest Baptist Medical Center (NC, USA) demonstrate that exercise does not worsen fibromyalgia-associated pain, and may even decrease it over time.
Fibromyalgia or fibromyalgia-like conditions affect approximately one in ten of the adult population in the USA that affects how pain signals are processed in the CNS. Individuals with the condition experience widespread musculoskeletal pain and often present with memory issues, sleep disturbance and fatigue. Some sufferers have reported that exercise can increase their pain, and so refrain from partaking in physical activity.
In a recent study, Dennis Ang, senior author of the study and associate professor of internal medicine at Wake Forest Baptist Medical Center (NC, USA), found that regular light-to-moderate exercise could improve overall symptoms, including an improvement in fatigue and trouble with sleeping. Ang explains, “For many people with fibromyalgia, they will exercise for a week or two and then start hurting and think that exercise is aggravating their pain, so they stop exercising. We hope that our findings will help reduce patients‘ fear and reassure them that sustained exercise will improve their overall health and reduce their symptoms without worsening their pain.”
In the study, 170 volunteers received individualized exercise prescriptions and were asked to complete baseline and follow-up physical activity assessments in the form of a Community Health Activities Model Program for Seniors (CHAMPS) questionnaire at weeks 12, 24 and 36.
The study found that the clinical symptoms of participants who exercised at a moderate intensity (i.e., light jogging or brisk walking for 20 mins per day) for 12 or more weeks were improved when compared with participants who could not exercise as regularly. This finding reflects the current medical recommendations for exercise in patients with fibromyalgia, and supports the assertion that long-term physical activity does not worsen fibromyalgia-related pain symptoms.
– Written by Sophie Breeze
Sources: Kaleth AS, Saha CK, MP Jensen, Slaven JE, Ang DC. Moderate-vigorous physical activity improves long-term clinical outcomes without worsening pain in fibromyalgia. Arthritis Care Res. (Hoboken) doi:10.1002/acr.21980 (2013) (Epub ahead of print); Wake Forest Baptist Medical Center news release: www.wakehealth.edu/News-Releases/2013/Regular_Moderate_Exercise_Does_Not_Worsen_Pain_in_People_with_Fibromyalgia.htm
Central post-stroke pain syndrome is frequently misdiagnosed, but once recognized, it can be treatable.
Central post-stroke pain (CPSP) is a chronic debilitating pain that approximately one in ten stroke patients suffer from, which is caused by damage to, or dysfunction of, the CNS. It presents as a sharp, stabbing or burning sensation. Up to two-thirds of CPSP patients also experience hyperpathia or allodynia.
CPSP is a form of neuropathic pain that is difficult to recognize owing to the fact it that can begin at any time in the days, weeks or months following a stroke. For example, in a study of CPSP patients, 63% were affected within 1 month, 18% within 6 months and the remaining 18% after 6 months.
The recent paper, published in Topics in Stroke Rehabilitation, describes the treatment options currently available, including medications such as amitriptyline, lamotrigine and gabapentin. Following failure with these, the paper recommends magnetic or electrical stimulation of the brain. This can be in the form of transcranial magnetic stimulation, motor cortex stimulation or deep brain stimulation.
The authors of the paper emphasized that recognizing CPSP and differentiating it from musculoskeletal pain or spasticity-associated pain is key to successful treatment of the condition.
– Written by Sophie Breeze
Sources: Flaster M, Meresh E, Rao M, Biller J. Central poststroke pain: current diagnosis and treatment. Top. Stroke Rehabil. 20(2), 116–123 (2013); Loyola University Newswire. Days or weeks after stroke, some patients develop chronic, debilitating pain. http://loyolamedicine.org/newswire/news/days-or-weeks-after-stroke-some-patients-develop-chronic-debilitating-pain
Researchers at Gothenburg University (Sweden) have recently reported in the journal Human Reproduction that a copper intrauterine device (Cu-IUD) does not affect the severity of dysmenorrhea (period pain), and a levonorgestrel-releasing intrauterine system (LNG-IUS) can actually reduce dysmenorrhea severity.
Many women are affected by dysmenorrhea and previous studies have reported that using a Cu-IUD can result in worsened dysmenorrhea. In this longitudinal population study, the researchers compared the severity of dysmenorrhea in 2102 women (random samples of 19-year-old women born in 1962, 1972 and 1982; n = 656, 780 and 666, respectively) over 30 years when they used either intrauterine contraception (LNG-IUS or Cu-IUD) or a combined pill. The researchers found that when the women used a Cu-IUD, their dysmenorrhea severity was no different to when they used other methods (e.g., condoms). However, when women used a LNG-IUS or a combined pill, it was found that their dysmenorrhea severity was reduced when compared with other methods (e.g., condoms).
Author Ingela Lindh from the Sahlgrenska Academy at Gothenburg University explained the significance of the study, “Research into period pain is sorely needed. Lowering the number of women who suffer from period pain will bring down absence from work and school and reduce the consumption of painkillers.”
The researchers concluded that this information could be of use to clinicians and users when deciding on which IUD to use. However, further research is needed into the affect of intrauterine contraception on the risk of developing abdominal pain between periods.
– Written by Natasha Leeson
Sources: Lindh I, Milsom I. The influence of intrauterine contraception on the prevalence and severity of dysmenorrhea: a longitudinal population study. Hum. Reprod. 28(7), 1953–1960 (2013); University of Gothenburg press release: www.sahlgrenska.gu.se/english/news_and_events/news/News_Detail/?contentId=1168374
A new study has demonstrated that individuals who regularly take prescription opioid painkillers are at a higher risk of developing erectile dysfunction.
Use of opioid painkillers is on the rise, with prescription opioid sales quadrupling between 1999 and 2010 in the USA. Approximately 4.3 million adults in the USA use opioid medications, such as morphine, hydrocodone and oxycodone, on a regular basis. In a new study, a team of researchers led by Richard Deyo, an investigator with the Kaiser Permanente Center for Health Research (OR, USA) and professor of evidence-based family medicine at Oregon Health and Science University (OR, USA), aimed to clarify concerns raised over the possible connection between long-term use of opioids and the development of erectile dysfunction (ED).
In the study, the health records of over 11,000 men were examined in order to find out if those taking prescription painkillers were more likely to be prescribed ED medications or testosterone replacement. The results were very revealing, showing that of those taking high doses of opioids for at least 4 months, over 19% were also prescribed ED medication, compared with 12% of those taking low-dose opioids and less than 7% of males not taking prescription opioids.
Dayo explains, “Men who take opioid pain medications for an extended period of time have the highest risk of ED. This doesn‘t mean that these medications cause ED, but the association is something patients and clinicians should be aware of when deciding if opioids should be used to treat back pain.”
The study demonstrated that ED prescriptions were 14-times more likely to be given to men over 60 years of age compared with men aged between 18 and 29 years. Even when taking this and other factors, such as depression and other medication, into account, researchers found that men taking high doses of opioids were a staggering 50% more likely to be prescribed medication for ED than men not taking prescription painkillers.
This study highlights the need for increased awareness of clinicians and patients when it comes to prescribing pain medication. Deyo concludes, “There is no question that for some patients opioid use is appropriate, but there is also increasing evidence that long-term use can lead to addiction, fatal overdoses, sleep apnea, falls in the elderly, reduced hormone production, and now ED.”
– Written by Sophie Breeze
Sources: Deyo RA, Smith DH, Johnson ES et al. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine (Phila. Pa 1976) 38(11), 909 (2013); Kaiser Permanente press release: http://xnet.kp.org/newscenter/pressreleases/nat/2013/051513-painkillers-and-erectile-dysfunction.html