Pain Relievers Create Silent Epidemic

Posting Date: 07/05/1999

Familiarity breeds carelessness. Millions of people pop pills every day to ease the pain of arthritis, headaches, low back or joint problems. They take their medicine for granted and often ignore the warning against using non-prescription pain relievers for more than 10 days at a time. Few people realize that medications such as aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) can cause serious complications and even death. A recent review in the New England Journal of Medicine revealed that over 100,000 people are hospitalized each year as a consequence of drug-induced digestive tract complications. At least 16,000 die. Although this death toll doesn't make headlines, it is comparable to the number of people lost annually to AIDS. In fact, NSAIDs are responsible for more deaths each year than all illicit drugs combined, including heroin, marijuana, cocaine and LSD. People rarely think aspirin or Aleve, Advil or Motrin IB are capable of causing problems. Prescription products such as Relafen, Daypro Lodine or Voltaren are swallowed with little appreciation of their potential danger. These medications are immensely popular because they alleviate inflammation and relieve the pain of tennis elbow, bursitis, sore knees and arthritis. Every year doctors write 70 million prescriptions for NSAIDs and people swallow more than 30 billion over-the-counter pills. Phil is a perfect example. He developed an ache in one knee and some stiffness in his fingers. Since he was already taking aspirin regularly to protect his heart, he figured a few more tablets would offer pain relief without problems. One day Phil woke up so weak he could hardly make it to the bathroom. He had no idea what was wrong because he had no prior symptoms. When his wife dragged him to the emergency room they discovered he had very low blood pressure and severe anemia due to a bleeding ulcer. He required several units of blood and days in the hospital to recuperate. Although 10 to 20 percent of people taking NSAIDs experience heartburn, indigestion or other signs of digestive distress, many who develop serious complications never notice any symptoms. As with Phil, the first sign that something is wrong may be a bleeding or perforated ulcer. According to the experts writing in the New England Journal of Medicine, "these toxic effects remain largely a 'silent epidemic,' with many physicians and most patients unaware of the magnitude of the problem." Those who are most vulnerable include older people, those who have already had ulcers and people who are also using cortisone-like drugs (prednisone) or blood thinners such as Coumadin (warfarin). Acid-suppressing drugs like Prilosec or Prevacid may help prevent some of the problems associated with NSAIDs. Physicians and patients are hoping that the new category of COX-2 inhibitors will prove safer than traditional NSAIDs. Celebrex and Vioxx have generated extraordinary excitement, but it will take time to assess their actual benefits and risks. In the meantime, people who rely on drugs such as aspirin, ibuprofen or naproxen need to stay vigilant. These pain relievers allow people to stay active and independent, but they remain double edged swords.

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