Nonsteroidal anti inflammatory drugs (NSAIDs) are commonly used to treat the pain and swelling of arthritis and other musculoskeletal conditions. NSAIDs come in prescription form (e.g. Celebrex, Mobic) and over the counter (e.g. aspirin, ibuprofen). Studies have shown that about 30% of people with some form of arthritis use over-the-counter NSAIDs on a daily basis. Many other people take a combination of prescription and OTC NSAIDs daily to manage their pain, even though long term NSAID use can lead to gastrointestinal problems and overuse can lead to drug toxicity.
A recent study published in the February issue of Arthritis & Rheumatism found an association between dual use of NSAIDs and poorer health status. The study defined dual use as taking two NSAIDS, either prescription or OTC, at least twice a week during the month before the study survey was conducted. 182 patients in a managed care organization participated in the study. Of these patients, half had either rheumatoid or osteoarthritis and one-fourth had chronic back pain. The researchers found that 26 percent of the participants were dual users of NSAIDs. Eighty percent of those dual users took one prescription and one OTC NSAID. Also, the dual users had significantly lower health care quality of life (HQROL) scores than non-dual users.
The authors discussed that this study was only able to show association and not the causal reasons for either dual use of NSAIDs or of the lower evaluation scores. The study also was not designed to determine whether dual users were receiving the maximum dosage of the first NSAID. But they did theorize that the lower physical quality of life scores might be attributed to inadequate pain management and that dual use of NSAIDs might be a marker for doctors to look for when evaluating a patient's pain. They stated that factors leading to dual use on NSAIDs might be inadequate pain management, lack of patient awareness of risk factors, lack of doctor-patient communications about the patient's use of OTC drugs and easy access to OTC medications. They called for more research to find better ways to educate patients and enable them to discuss their pain with their doctors. They also called for more appropriate pain management strategies in order to reduce the dual use of NSAIDs, improve patient symptoms and reduce patient safety issues.
In summary, patients who take more than one NSAID on a regular basis, especially those taking OTC NSAIDs, should talk to their doctor about the risks and whether there might be another strategy to manage their pain.
