NSAIDs and Chiropractic : conventional risk vs. conventional solution


Information on NSAIDS (non steroidal anti inflammatory drugs)   

  • The most common conventional first line treatment for most musculoskeletal pain syndromes is nonsteriodal anti-inflammatory drugs. (NSAIDs)
  • Gastrointestinal ulcers can lead to fatal complications such as hemorrhage and perforation.
  • At any given time, the chance of a patient on NSAID therapy having a gastric ulcer is 10% to 20%, a rate 5-10 times greater than non-users.
  • One retrospective study reported that nearly 80% of all ulcer related deaths occurred in patients using an NSAID.
  • One study published in The New England Journal of Medicine estimated that at least 103,000 patients are hospitalized per year in the united stated for serious gastrointestinal complications due to NSAID use for all conditions.
  • At an estimated cost of $15,000 to $20,000 per hospitalization, the annual direct cost of such complications exceed $2 billion. {Wolfe MM, Lochtenstein DR, Singh G: Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. NEJM 340;1888-1999}
  • This study estimated that 16,500 NSAID related deaths occur among patients with rheumatoid arthritus or osteoarthritus every year in the United States.
  • This figure is similar to the annual number of deaths from AIDS and considerably greater than the annual deaths from multiple myeloma, asthma, cervical cancer or Hodgkin’s dx.
  • If deaths from gastrointestinal toxic effects of NSAIDS were tabulated separately in the National Vital Statistics report, these effects would constitute the 15th most common cause of death in the US.
  • Complications from NSAID use do not result only from chronic, long term use.  One meta-analysis found short term NSAID use was actually associated with a higher risk of GI complications than chronic use.
  • Another double blind trial found that 6 of 32 (19%) healthy volunteers developed a gastric ulcer that was visible on endoscopic examination after 1 weeks treatment with naproxen (at a commonly prescribed dose of 500mg twice daily.)  {Simon LS, Lanza FL, Lipski PE et al; Preliminary study of the safety and efficacy of SC-58635, a novel cyclooxygenase 2 inhibitor. Arthritus Rheum 41;1591 1998.}
  • Besides GI complaints, other less common side effects of NSAIDS include hypersensitivity reactions, cardiovascular disease, liver damage, and central nervous system damage.
  • Kidney disease is also infrequent but potentially a serious complication.
  • One study found NSAID use was associated with a 4-fold increase in hospitalization for acute renal failure, a risk that was dose-dependent and occurred especially in the first month of NSAID therapy.
  • Some studies have raised serious questions regarding the appropriateness of using NSAIDs in cases of osteoarthritus.
  • There is no evidence that NSAIDs favorably influence the progression of joint breakdown in OA.
  • Several animal studies and human clinical studies that have actually implicated NSAIDs in the acceleration of joint destruction. {Brandt KD: Should arthritus be treated with nonsteroidal anti-inflammatory drugs? Rheum Dis Clin N AM 19-697, 1993}
  • NSAIDs are used effectively for pain relief and anti-inflammatory effects and are generally considered safe.
  • There is NO evidence that they are more effective for long-term treatment than conservative chiropractic care for acute or chronic musculoskeletal disorders.

(above research compiled by Dr. W.J. Lauretti, DC)

Here is some extra credit information for you:

  • NSAIDS block the COX enzymes, COX-1 &COX-2, and block the production of prostaglandins reducing stomac and platelet support while inhibiting blood clotting ability.
  • Depletes nutrients such as Folic Acid. You can add Vit C, Iron, Potassium, Sodium when taking Aspirin.
  • Side effects: Diarrhea and constipation, decreased appetite, rash, dizziness, head aches, drowsiness, fluid retention leading to edema, kidney failure, liver failure, ulcers, prolong bleeding after surgery or injury, ringing in ears.

Do you recognize any of these generic and brand name NSAIDs?

Aspirin
Anacin, Ascriptin, Bayer, Bufferin, Ecotrin, Excedrin
Meclofenamate sodium
Meclomen
Celecoxib
Celebrex
Mefenamic acid
Ponstel
Choline and magnesium salicylates
CMT,Tricosal, Trilisate
Meloxicam
Mobic
Choline salicylate
Arthropan
Nabumetone
Relafen
Diclofenac sodium with misoprostol
Arthrotec
Naproxen
Naprosyn, Naprelan
Diclofenac potassium***
Cataflam
Naproxen sodium
Aleve, Anaprox
Diclofenac sodium
Voltaren, Voltaren XR
Oxaprozin
Daypro
Diflunisal
Dolobid
Piroxicam
Feldene
Etodolac
Lodine, Lodine XL
Fenoprofen calcium
Nalfon
Rofecoxib
Vioxx
Flurbiprofen
Ansaid
Salsalate
Amigesic, Anaflex 750, Disalcid, Marthritic, Mono-Gesic, Salflex, Salsitab
Ibuprofen
Advil, Motrin, Motrin IB, Nuprin
Sodium salicylate
various generics
Indomethacin
Indocin, Indocin SR
Sulindac
Clinoril
Ketoprofen
Actron,Orudis, Orudis KT, Oruvail
Tolmetin sodium
Tolectin
Magnesium salicylate
Arthritab, Bayer Select, Doan’s Pills, Magan, Mobidin, Mobogesic
Valdecoxib
Bextra

OTHER HELPFUL LINKS TO ENJOY:

http://articles.mercola.com/sites/articles/archive/2008/01/02/nsaids2.aspx

http://articles.mercola.com/sites/articles/archive/2011/03/15/common-painkillers-linked-to-increased-risk-of-heart-problems.aspx

http://www.drjohnm.org/2011/05/cw-more-on-the-dangers-of-nsaids/

http://carychiropractor.wordpress.com/2010/06/30/nsaid-vs-chiropractic-care-for-low-back-pain-lbp/

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