Nearly 25 million American adults suffer from pain on a daily basis and 23 million report experiencing severe pain.1In fact, pain affects more Americans than diabetes, heart disease and cancer combined and is cited as the most common reason Americans access health care.
Pain is a major contributor to health care costs and a leading cause of disability.2 The WHO, or World Health Organization estimates at least half adult population in the world experienced at least one headache in the past year.3 In the U.S. nearly 70 million prescriptions are written and 30 billion doses are consumed when over-the-counter (OTC) NSAIDS are included.4 Although they may appear safe as they are sold in local convenience stores, by conservative estimates, over 105,000 people are hospitalized every year from side effects of these drugs and over 16,000 have died.5 Long-term side effects from NSAIDS are varied, but research demonstrates short-term use significantly increases your risk of heart attack.6
One recently published study in the British Medical Journal examined cardiovascular risk in individuals taking the NSAID called diclofenac (marketed in the USA under the names Voltarol or Voltaren) compared against other traditional NSAIDS.7 Danish researchers used 252 cohort studies mimicking the design strategy, which included more than 6.3 million adults who had at least one year of continuous prescription records. They analyzed the data to evaluate the risk of major adverse cardiovascular events occurring within 30 days of first taking diclofenac, naproxen, ibuprofen or paracetamol.8 The research team at Aarhus University hospital in Denmark, concluded adverse event rates in those taking diclofenac were 50 percent higher than those who took no NSAIDS.9
Documented adverse events included atrial fibrillation, ischemic stroke, heart failure and myocardial infarction. The results of the study prompted the researchers to make strong recommendations for clinical use and future study: “It is time to acknowledge the potential health risk of diclofenac and to reduce its use. Diclofenac should not be available over the counter, and when prescribed, should be accompanied by an appropriate front package warning about its potential risks. More specifically, the choice to use diclofenac as the reference group to provide evidence of safety of selective COX-2 inhibitors represents a potential flaw in safety trials. Future trials should instead use low dose ibuprofen (less than 1200 mg/day) of naproxen (less than 500 mg/day) as the comparison group. In conclusion, our data support that initiation of diclofenac poses a cardiovascular health risk, both compared with no use, paracetamol use, and use of other traditional NSAIDS.”10
When the results of the study outlined above where compared against ibuprofen and naproxen the researchers found those medications increased the risk of cardiovascular events 30 percent over those who did not take the medications. The result of this study confirm those of previously published studies that have also found those taking naproxen and ibuprofen are at higher risk of having a heart attack.11
FDA Warns but few heed the warnings
In July 2015 the FDA strengthened the required warnings for OTC NSAIDS based on a comprehensive review of safety information and required updates on drug labels of all prescription NSAIDS. The warnings include a mention of rising risk of heart attack and stroke. Despite the number of prescribed NSAIDS or OTC purchases have not halted. The initial warning from the FDA came shortly after Merck voluntarily pulled Vioxx, an NSAID Cox-2 inhibitor, off the shelves. Of the 4 million Americans who had taken Vioxx prior to the recall, it’s estimated the drug caused 140,000 heart attacks and resulted in an estimated 60,000 deaths.12
Another issue for NSAIDS, is that women in their childbearing years need also be aware that when these drugs are taken around the time of conception or early in the pregnancy it significantly increases the risk of miscarriage, in the first eight weeks.13
Some safer alternative options do exist
Acupuncture – an estimated 3.5 million Americans use acupuncture for relief from pain associated with a number of physical conditions, including fibromyalgia, migraine headaches, back pain or injuries.
Vitamin D – optimizing your production of vitamin D by getting appropriate sun exposure will work through a variety of different mechanisms to reduce your pain.
Omega 3 Fats – the fat contained in animal-based omega-3, EPA and DHA, have demonstrated a reduction in inflammation and benefit in pain relief in many animal and clinical studies. Your best food sources include mackerel, herring, anchovies and wild-caught Alaskan salmon. Consider supplementation if you don’t include an abundance of these foods in your diet.
Bromelain – a protein-digesting enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form, but eating fresh pineapple may also be helpful. Keep in mind most of the bromelain is found within the core of the pineapple, so consider leaving a little of the pulpy core intact when you consume the fruit.
Curcumin – this is the primary therapeutic compound in turmeric. Curcumin has been shown in multiple studies to have potent anti-inflammatory activity, as well as demonstrating the ability in four studies to reduce Tylenol-associated adverse health effects. 15
Ginger – is an anti-inflammatory herb that offers pain relief and stomach settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice and is also found along with curcumin in many vitamin capsules.
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- National Center for Complementary and Integrative Health, Estimates of Pain Prevalence and Severity
- Department of Health and Human Services, Pain Management
- World Health Organization, Headache Disorders
- MedScape, December 20, 2017
- American Nutrition Association 2016;38(2)
- BMJ 2018;362:k3426
- Birmingham Live, September 7, 2018
- MedicalXpress, September 4, 2018
- MedicalXpress, September 4, 2018.
- BMJ 2018;362:k3426
- BMJ 2017;357:j1909
- Drug Watch, Vioxx
- Reuters, June 20, 2018
- Drug Watch, Vioxx
- Harvard Health Publishing, July 13, 2015
References for this newsletter as well as previous newsletters may be found on our website.
The information has not been evaluated by the FDA and is not intended to treat, cure, or prevent any disease.