In search of the perfect pill... what does all of this mean?

Whether you saw it on TV, heard it on the radio or read it either in the newspaper or online, you cannot seem to get away from it. Now another medicine used for the treatment of pain in under fire. This time it is not an opioid with governmental restrictions. This time the medicine is one that most physicians and other healthcare professionals were at least more willing to prescribe, namely the non-steroidal anti-inflammatory drugs (also called NSAIDs).

In Sept 2004, Vioxx, a COX2-inhibitor NSAID, was removed from the market by Merck due to reported increased risk of heart attack. You were advised to speak with your healthcare provider about what alternatives were available. At that time, Bextra and Celebrex were considered the reasonable options especially if you could not take the familiar NSAIDs like Ibuprofen or Naproxen. Now, isolated studies have begun to question the safety of both Bextra and Celebrex as well as Naproxen, which is one of the NSAIDs (NSAIDs block both COX1 and COX2).

You may live with a pain problem caused from constant inflammation, such as arthritis, lupus, fibromyalgia or endometriosis. This may mean that you need to take these medicines every day, several times a day for months or years. Naturally, you become worried when you hear the news. But what if you take these kinds of medicines for pain problems, like migraine headaches, menstrual cramps, low back pain or recurrent kidney stones? This may mean that you need to take these medicines periodically but with regular episodes. With these new and confusing reports, you may be anxious and fearful about what to do next.

How about those of us who take over the counter (OTC) medicine either with or without the knowledge or permission of our doctors, nurses or pharmacists? Have you taken a look to see what is contained in most OTC medicine you take for sinus congestion, colds, sleeplessness or hay fever? Is there any medicine out there that is perfectly safe?

No! All medicines have risks as well as benefits. Even herbal remedies, considered by some as a “natural alternative” have risks as well as possible benefits (given that herbal remedies are not regulated, these medicines may carry even greater risks). What are you suppose to do?

First, it is most important to be informed about your medicines in a balance fashion. Your healthcare professional should be talking with you about what to expect for pain relief as well as what BOTH of you should be watching for that could be potentially harmful for you. The next step is to decide whether the benefit of taking the medication outweighs the risk of exposure over time. Regular monitoring by office visits and telephone contacts will lower the chance of causing more harm than good.

Next, keep in mind that pain it itself may not be safe. Evidence suggests that untreated pain may also harm your health. Clearly, much more pain research is needed to find better solutions.

In the mean time, strive for balance. The cardiac risks identified seem to affect a small number of subjects participating in studies. Our scientists need time to understand the full meaning rather than jump to rash conclusions.

Take a deep breath! Think before you act. Discuss your pain management plan with your healthcare professional and understand that taking any medication is a process of balancing possible benefits with possible risks.

December 23, 2004