When all’s NSAID and done?

Drugs are having a bad time this year.  The latest batch to come under the hammer are Non-Steroidal Anti-inflammatory Drugs (NSAID) in general and Ibuprofen in particular.   An observational trial has revealed a higher incidence of atrial fibrillation in people taking these drugs with a previous study way back in 2005 highlighting cardiovascular problems after a myocardial infarction.

These drugs have had problems for many years, their relation to aspirin meaning that gastro-intestinal haemorrhage can be a problem.  The present problem can only be highlighted after many years of experience with drugs because the problems take so long to develop.

The problem is that, if people stop taking them, what else is there for pain relief?

Before answering this question, it is important to emphasise that none of this discussion affects low dose aspirin for the prevention of cardiovascular incidents in “at risk” people.  This is still by far the best way of preventing attacks and prolonging life.

So, back to the question: how to relieve pain.  What are the possibilities?

1.  Paracetamol
Safe when taken in the recommended dosage but serious side effects in higher doses.  That is why the pack size you can buy is so small.  Good for mild to moderate pain

2.  Aspirin and NSAIDs
Problems with gastro-intestinal haemorrhage and with cardio vascular problems but good relief of moderate pain and excellent anti-inflammatory properties.

3.  Opiates
Good relief of moderate to severe pain.  Addiction with more powerful and maybe with less powerful versions such as codeine and tramadol.  Constipation and nausea can also often occur.

It is best to avoid combination drugs such as Codis and Solpadeine.  These have enough codeine in to cause side effects but not enough to relieve pain.

If nothing else, the present problems that are being highlighted emphasise that the prescribing of any drug is a balancing act.  The drug has not yet been invented that does not have any side effects; just look through the British National Formulary (BNF) and you will see that.

Therefore, prescribing a drug is a balancing act between the beneficial and harmful effects of a drug.  If the former outweigh the latter then that is alright.  On many occasions, the patient will be a party to any decision about prescribing that is made.

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