Many people take non-steroidal anti-inflammatory drugs (NSAIDs) to relieve their muscle and joint pain. These medications may be particularly effective in conditions in which pain results primarily from inflammation, such as arthritis or athletic injury. Recently, the Food and Drug Administration (FDA) has provided more safety guidance concerning these over the counter drugs. General examples of commonly used over-the-counter OTC NSAIDs include ibuprofen and naproxen. Aspirin is also an NSAID, but was not cited in the new FDA statement. With this new information concerning NSAIDs, what are doctors prescribing to their patients to relieve mild to moderate pain?
“Whenever a part of the body is in trouble, pain is a common reaction,” says Dr. Aristotle Economou, a leading practitioner of alternative medicine in Beverly Hills. Our system sends cells to the area to help get rid of the cause of a problem. In the meantime, inflammation is the body’s way of protecting the area. During the inflammatory process, other cells are called in which also increase the chemical reaction and sensation of pain.”
“As we know, pain is serious and is one of the many common reasons people visit a doctor,” says Dr. Economou. “However, what we tend to forget is that pain is rarely the problem. Finding the root cause is the best approach. But what can we do in the meantime? The general public is frustrated due to the repeated warnings by the FDA and consumer advisory committees on NSAID pain relievers and the potential side effects such as heart attacks and strokes. Physicians are being asked to find other alternatives for pain relief. Patients that have relied on pain medication are beginning to panic as to what alternatives are available to them.”
“I still tell most patients that it is OK to take NSAIDs occasionally for mild to moderate pain,” says James A. McGowan, M.D., who specializes in advanced pain treatment options at The Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore. He is Board Certified in Pain Medicine and Anesthesiology and has also been recognized as a Top Doc by Baltimore magazine. “Exceptions to this advice include patients with a significant history of heart disease, kidney disease or ulcers. If a patient had one of these conditions, or if he or she was concerned about potential side effects of NSAIDs, I would recommend another over the counter medication such as an acetaminophen or a non-pharmaceutical remedy such as heat, ice, rest, or elevation. It’s important to remember, however, that no medication is without potential adverse effects. Although acetaminophen is not thought to affect the heart, it can have adverse effects on the liver.”
What role do OTC topical analgesic medications, such as the Salonpas® line, play in doctor recommendations today? “I feel that OTC topical pain relieving agents are generally safe and sometimes effective for certain pain issues,” says Dr. McGowan. I do often recommend topical pain relieving agents, especially in patients whose pain is isolated to a single body area that can be effectively targeted with a topical agent, such as a foot or a knee. These medications tend to have fewer side effects than pills, and are often helpful, and so I feel they are usually at least worth a try for patients in pain.”
“Direct application of topical analgesics has advantages in that it is applied directly to the site of pain,” says Dr. Economou. “This makes it simple for everyone regardless of your situation. Relief is generally immediate and can applied with ease. Topical application also allows for a more concentrated approach to pain relief. Taking oral pain relievers regardless if it’s natural or not still takes time to travel through the digestive system. It can become diluted by the time it reaches the area of pain or injury especially for muscle or joint pain. Patients enjoy the simplicity of applying a topical. They can carry it with them and apply it anywhere. Whether they are relaxing in a movie theater or training for a marathon, it is a fast and convenient way to obtain pain relief.”
Dr. Economou’s book “Change the Way You Heal: 7 Steps to Highly Effective Healing” instructs patients to rub pain points or apply heat-producing topicals to the points (except the face). This graphic depicts the pain relief chart with access to the easy-to-find location of “wellness points,”,also known as pressure points, necessary for addressing more than 100 types of common health challenges.
“For patients in pain, I recommend therapeutic doses of a highly absorbable form of magnesium such as magnesium citrate powder mixed with hot or cold water and sipped throughout the day,” says Carolyn Dean, MD, ND, Medical Advisory Board Member, Nutritional Magnesium Association. “Magnesium cools inflammation. Heart disease begins with inflammatory chemicals that burn like a fever through your blood vessels. By getting the recommended daily minimum of magnesium you can cool down the heat.”
“Chronic inflammation is the main contributing factor to heart disease and magnesium is a very safe and effective anti-inflammatory,” adds Dr. Dean.
“Magnesium safely reduces inflammation and systemic stress because magnesium deficiencies are in great part the cause of both conditions.”
“There is an option to help decrease the dependency on pain medication by combining time-tested Eastern medicine with Western technology,” says Dr. Economou. “Laser acupuncture is by far one of the most powerful and non-invasive methods of pain relief. In over 25 years of clinical practice I have personally witnessed the incredible pain relieving results of laser acupuncture.”
“I always recommend against taking two NSAIDs simultaneously, as the combination of two or more NSAIDs increases the risk of side effects and complications,” says Dr. McGowan.
“Since NSAIDS can be sought out by patients by prescription and over the counter (OTC) it is common practice for people to take them at the same time, not knowing they are in fact taking two medications in the same therapeutic class of drugs,” says Dr. Economou. “This commonly results in a greater risk of gastrointestinal problems.”
In 2008 a study, that involved 138 patients was published in Arthritis Care and Research, showed that those taking two NSAIDS was related to lower scores on a health related quality of life assessment.
How does someone know they are having a negative reaction to the NSAID? “Some adverse reactions will have very obvious symptoms that are felt immediately,” says Dr. McGowan. “For instance, an allergic reaction to an NSAID will present as itching, rash, or difficulty breathing. Some adverse reactions may present more gradually. The development of stomach ulcers that can result from prolonged NSAID use may initially be felt as mild to moderate stomach pain before the severe pain or bleeding of the ulcer is noticed. Other adverse effects may not be noticed at all until a serious problem has developed. Coronary disease or kidney disease related to NSAID use may not be noticed by a patient at all until the condition culminates in a heart attack or kidney failure.”
Besides NSAIDs, what are other risk factors for heart disease and stroke? “Without question, there are much more significant risk factors for heart disease and stroke than taking NSAID medications,” says Dr. McGowan. “Tobacco use, obesity, high cholesterol, and a family history of heart disease play a much larger role in the development of heart disease than NSAID use. We know that NSAID use can contribute to heart disease, but the best ways to prevent heart disease are still weight loss, exercise, smoking cessation, and eating a healthy diet.”
“Research does show that NSAID use increases the risk of heart disease even in patients without risk factors for heart disease, although the estimates vary for just how much this risk increases in these individuals,” adds Dr. McGowan.
“Many people on cardiac medication such as statins will have a deficiency of the nutrient CoQ 10,” says Dr. Economou. “This is a contributing factor to developing congestive heart failure. That’s why it’s crucial those on statin drugs complement their diet with a high quality CoQ10 supplement.”
Dr. Economou concurs with Dr. Dean regarding the benefits of magnesium, saying that “another common nutrient deficiency that increases the risk of high blood pressure, high cholesterol and heart attack is magnesium. As you read this, I can imagine those of you reaching for your latest blood test and double-checking your magnesium levels. Good decision! However, a word of caution here: make sure you were tested for magnesium levels ‘inside’ the red blood cell (rbc); also called intracellular magnesium. Not in the serum. Most of your magnesium is located in the red blood cell. Only about 1% of magnesium in the body is in the serum. As your magnesium levels quietly drop inside the red blood cell (this helps regulate your heart rhythm) the body will compensate by increasing your serum magnesium. With a serum magnesium high, your blood test will show normal if the correct test is not ordered. This leaves you susceptible to serious cardiac problems.”