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Author: admin, 05.07.2014. Category: Ring In The Ears

The management of pain should be individualized for each patient and typically involves both nonpharmacologic and pharmacologic therapies. Public health advisory - FDA announces important changes and additional warnings for COX-2 selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs).
Desai SP, Solomon DH, Abramson SB, et al; American College of Rheumatology Ad Hoc Group on Use of Selective and Nonselective Nonsteroidal Antiinflammatory Drugs. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older Persons.
Acetaminophen overdose and liver injury — background and options for reducing injury.
ShareUsing NSAIDs to manage chronic neck pain could almost double your risk of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism, according to new research published in the journal Rheumatology.
The new meta-analysis looked at published observational studies in order to assess the association between NSAID use and these dangerous types of blood clot. Venous thromboembolism (VTE) is, thankfully, relatively rare, which is why these researchers had to use observational studies (VTE occurs rarely in clinical trials).
The potential for adverse events with the use of COX-2 inhibitors has actually been known for many years. The benefits of COX-2 inhibitors for pain from conditions such as arthritis have been well documented in clinical trials, but the potential doubling of the risk of blood clots may have people with chronic pain conditions thinking twice about using celecoxib and rofecoxib. Alternative pain relief options do exist, including natural inhibitors of COX-2 enzymes that do not appear to increase the risk of VTE when taken at their recommended dosage (although further study is certainly warranted to get a clearer picture of this risk). Excessive consumption of fish (more than 46g a day) does appear to increase the risk of stroke, but at lower doses omega 3 from fish oil actually reduces the risk of stroke while offering relief from pain and inflammation. NSAIDs may remain popular for treating chronic neck pain and other pain conditions but they are typically contraindicated after surgery involving fusion as they can decrease healthy bone growth. Previous post: Most Commonly Used Herbs to Combat Neck Pain – Do any of these remedies actually work? Increasing attention is being attracted to the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), which are analgesic compounds that are quite effective in treating numerous musculoskeletal disorders.
Many drugs are overprescribed, and many patients consume excessive amounts of analgesic, laxative or psychoactive drugs, but the magnitude of the use of NSAIDs is almost incredible. A major television inquiry was made concerning marketing practices and the responsibility of the medical profession in postmarketing surveillance due to the removal of benoxaprofen (Opren) from the market in the United Kingdom. However, this type of reporting and data collection has many drawbacks despite the fact that it’s a laudable attempt to focus attention on the problem of reactions to drugs. However, the less well known but potentially dangerous side effects of NSAIDs on renal function, electrolytes and blood pressure still aren’t reported by the system.
Inhibition of cyclo-oxygenase and thus, reduction of prostaglandin production are probably the result of most of the actions of NSAIDs.
However, it is likely that NSAIDs reduce renal blood flow and the glomerular filtration rate predictably and uniformly in patients in whom renal perfusion is stressed by other factors including reduced effective blood volume or pre-existing renal disease.
Clinical evidence suggests that NSAIDs usually produce a decrease in the glomerular filtration rate and an increase in the serum creatinine level in patients who are receiving diuretics or who have cirrhosis, nephrotic syndrome, cardiac failure, renal impairment, a salt deficit or systemic lupus erythematosus. Using NSAIDs may pose a special risk in older patients, especially if it’s given in combination with a diuretic, because the glomerular filtration rate decreases with age. In case an underlying renal disease is present, NSAIDs seem to occasionally contribute to episodes of acute renal papillary necrosis. NSAIDs are known to reduce the antihypertensive effects of diuretics (3-blockers and captopril), and they also reduce furosemide-induced natriuresis. Nephrotic syndrome, interstitial nephritis and vasculitis probably represent allergic phenomena that could be caused by many drugs and that occur in only a very small proportion of the vast numbers of patients taking NSAIDs. However, the reduction in the flow of renal blood and the rate of glomerular filtration may be a different matter. The incidence of transient renal impairment and acute tubular necrosis can be identified and then reduced with the help of further study of patients at risk. Disclaimer : This site does not endorse or recommend any medical treatment, pharmaceuticals or brand names.


While there are many conditions associated with pain necessitating treatment, including migraine and dysmenorrhea, musculoskeletal pain continues to be one of the most common. Nonpharmacologic treatment may include bed rest, bracing, manipulation and mobilization, traction, and therapeutic modalities such as transcutaneous electrical nerve stimulation, electrical stimulation, ultrasound, superficial heat, cryotherapy, and exercise.
Consultation between pharmacists, patients, physicians, and other HCPs regarding pain management is not an uncommon practice, and pharmacists have an incredibly important responsibility in these communications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a popular prescription and over-the-counter remedy for relief of inflammation and pain but these drugs are far from safe, especially when used for chronic conditions. They included 1 cohort study involving 19,293 people and 215 VTEs, and 5 case-control studies involving 21,186 cases, along with 110,824 controls. Prostacyclins are potent inhibitors of platelet activation and thromboxanes are potent facilitators of platelet aggregation in active platelets. In fact, rofecoxib (commonly known as Vioxx) was removed from the market in 2004 because research revealed a significant increase in heart attacks and strokes in those taking this particular NSAID. Curcumin and resveratrol appear to thin the blood and reduce platelet aggregation, thereby reduce the risk of blood clots and stroke.
Non-steroidal anti-inflammatory drugs and risk of venous thromboembolism: a systematic review and meta-analysis.
The rheumatologists who were filmed enjoying a trip to Venice funded by the maker of another new NSAID as well as the academic community were severely criticized for less than meticulous objectivity in reporting studies funded by pharmaceutical companies. For reporting adverse reactions to drugs, the committee on drugs and pharmacotherapy of the Ontario Medical Association (OMA) has established a program. Some of these drawbacks were acknowledged by the committee, such as the lack of information on the true incidence of reactions related to the population at risk, and the tendency to report reactions to newer drugs more frequently.
The physicians submitted only 30% of the reports received, while the hospital pharmacists submitted over half of the reports. After treatment with NSAIDs, there have been many recent reports of renal impairment that contain the same deficiencies as those on gastrointestinal side effects. It isn’t surprising that interference with prostaglandin synthesis might affect renal function, because prostaglandins probably play a major role in mediating changes in renal perfusion, despite the fact that the nature of these effects and their relation to other vasomotor systems have not been fully worked out yet. Even though this could sometimes progress to full-blown acute tubular necrosis necessitating dialysis, but in most cases it is reversible with the cessation of therapy.
All of these drugs have produced classic allergic interstitial nephritis on occasion, usually presenting as acute renal failure, often nonoliguric.
Episodes of hypersensitivity vasculitis and cutaneous vasculitis have been attributed by anecdotal reports to these drugs, but the frequency of these complications is very low.
A small degree of fluid retention commonly occurs, but it becomes a clinical problem only in some rare cases.
NSAIDs have also shown to reduce the effects of antihypertensive drugs by as much as 50% in hypertensive patients, but they don’t have any significant effect on the blood pressure of healthy people. Although this requires more study, but it seems that one of the NSAIDs called sulindac may not have this adverse effect on renal function. However, the effectiveness of these medications may wane with continued use as patients develop opioid tolerance. Additionally, pharmacists can evaluate for potential adverse events and drug interactions by reviewing patients’ pharmacotherapy history and comorbid conditions. The researchers, working at the Bassett Medical Center and Columbia University College of Physicians and Surgeons, New York City, found that a statistically significantly increased VTE risk among NSAID users and noted that physicians should be aware of this increased risk, especially if prescribing NSAIDs to people whose risk of dangerous blood clotting is already high. Studies took place in the United Kingdom, France, the Netherlands, Denmark, and Sweden between 2007 and 2013. COX-1 inhibitors, like aspirin, have actually been seen to effectively prevent VTE, so the increased risk of this potentially fatal complication likely stems from the use of COX-2 inhibitors. Other NSAIDs such as celecoxib have since had to display warnings on their labels regarding the risk of stroke and heart attack. These natural pain relief products could, however, increase the risk of problematic bleeding and should be discontinued at least a week prior to elective surgery. Anyone using NSAIDs such as celecoxib for chronic neck pain should consult their physician to discuss alternative options if they are concerned about the risk of dangerous blood clots and stroke.


Of all the adverse reactions reported, NSAIDs were responsible for 10%, and 53% of those were considered serious cases. Additionally, many nephrologists believe that a large percentage of drug-induced renal damage as well as electrolyte disturbances and difficulties with control of blood pressure are caused by NSAIDs. If pharmacologic doses are used, infusion of most prostaglandins into the kidneys of experimental animals produces increases in renal blood flow. The reduction in renal function may contribute significantly to morbidity and mortality because even though the reduction in renal function is reversible, but the cause of renal deterioration in these patients may not be identified, or the deterioration may be attributed to the underlying disease.
The lesion is clinically and pathologically indistinguishable in many of these cases from that produced by other unrelated drugs, especially diuretics and antibiotics, however, there are also more than 20 reports of the concurrent appearance of allergic interstitial nephritis and a nephrotic syndrome characterized histologically only by effacement of the foot processes in the glomeruli. Hyperkalemia is the most important and potentially dangerous electrolyte disturbance, which could become a life-threatening problem.
On the package inserts of most NSAIDs, warnings about drug-induced renal damage are written in very small letters, if at all.
The risk of hyperkalemia usually exists in patients with pre-existing renal disease whose potassium level would be monitored anyway; but despite this, the risk of hyperkalemia seems definite. Clinical evidence of reduced liver function, congestive heart failure, renal disease, or any evidence of reduced blood volume identifies patients in whom renal function at the very least should be carefully monitored in case they have been prescribed NSAIDs.
There are reports of very small doses inducing renal impairment, so that whether the reductions in the glomnerular filtration rate induced by NSAIDs are dose related or not is still not clear. More specifically, pharmacists can help reduce over-usage of acetaminophen from multiple products, advise on lowest effective dosing for OTC NSAIDs, monitor for signs of opioid abuse, and help patients understand the risks and benefits of their medications. Try These Five Foods That Can Help You SleepNatural Neck Pain Relief Within 30 Minutes – How Effective is Celadrin Cream for Arthritis and Myofascial Neck Pain Syndrome? Reporting of adverse side effects is inevitable with such a large exposure, but because a few studies have identified the true incidence of a given complication within an identified population taking the offending medication, assessment of the significance of such effects is difficult.
Almost all of the serious reactions were episodes of gastrointestinal bleeding, with or without proven peptic ulceration. In anesthetized animals, NSAIDs have been shown to reduce the flow of renal blood, but not in intact, conscious dogs. It has been suggested that this combined lesion may be due to uncontrolled production of lymphokines from sensitized T lymphocytes; this combined lesion also appears to be almost specific to NSAIDs. Hyperkalemia could result from changes in transecellular potassium transport, but since it is known that NSAIDs suppress rennin production, particularly in patients with pre-existing renal disease, so hyperkalemia may also be due to hyporeninemic hypoaldosteronism. Because several renal damages don’t even rate a mention, the reports of the OMA committee on drugs and pharmacotherapy might be interpreted as providing support for this. The risk of loss of blood pressure control should present a major problem only in some rare cases, so this risk should be more widely recognized. All patients with a high plasma rennin level that indicates some stress on renal perfusion are included in this group.
Some of the reported side effects have necessitated the removal of individual drugs from the market because they were dramatic, and the importance of side effects has been overplayed in some cases, given the evidence available. The gastrointestinal side effects of NSAIDs are now widely known and are acknowledged in package inserts and advertising material, so that most of those reactions couldn’t have been missed. There’s only little evidence that inhibition of prostaglandin production has any effect on renal blood flow or the glomerular filtration rate in healthy humans.
Withdrawal of the offending drug usually resolves both interstitial nephritis and the nephrotic syndrome, whether steroid therapy is used or isn’t.
In treating musculoskeletal and rheumatic ailments, many people will continue to require and benefit from NSAIDs. But the possibility of renal impairment should always be considered, and after a few days of treatment, the renal function of patients whose function may already be stressed should be evaluated. Even though the adverse effects of NSAIDs on renal function are less clamant than the gastrointestinal effects, but they are probably as dangerous, potentially avoidable or reversible if care is taken, but less easily identified.



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