International Herald Tribune Editorial - Pain relief, step by step
International Herald Tribune Editorial - Pain relief, step by step
Copyright by The International Herald Tribune
Published: March 1, 2007
Much attention has been focused on the cardiovascular risks posed by Vioxx and other so-called cox-2 inhibitors in recent years, so the American Heart Association provided an important service this week by reminding us that many other painkillers have risks associated with them. The association spelled out gradations of risk and recommended a step-by-step approach that doctors should follow when treating joint and ligament pain.
A lot has happened since the heart association issued a similar advisory two years ago. The evidence has gotten even stronger that the cox-2 inhibitors — Celebrex is the only one left on the market in the United States — increase the risk of heart attacks and strokes. New evidence has emerged that some other painkillers also increase the cardiovascular risks.
The most striking recommendation is that pain treatments should start with nonmedicinal approaches, such as physical therapy and exercise, weight loss to reduce stress on joints, and hot or cold packs. Only if those don't provide enough relief should drugs be used, and the doctor should take a step-by-step approach.
The first medication would usually be acetaminophen or aspirin at the lowest effective dose, or certain other low-risk drugs. Only if those fail should doctors progress to riskier drugs, starting with naproxen and then perhaps ibuprofen, both available over the counter. A cox-2 inhibitor should be prescribed only as a last resort.
The overall message is that one should use the lowest effective dose of the safest drug for the shortest period of time. That is always good advice, but it tends to be forgotten in an age when drugs are so heavily promoted.
Copyright by The International Herald Tribune
Published: March 1, 2007
Much attention has been focused on the cardiovascular risks posed by Vioxx and other so-called cox-2 inhibitors in recent years, so the American Heart Association provided an important service this week by reminding us that many other painkillers have risks associated with them. The association spelled out gradations of risk and recommended a step-by-step approach that doctors should follow when treating joint and ligament pain.
A lot has happened since the heart association issued a similar advisory two years ago. The evidence has gotten even stronger that the cox-2 inhibitors — Celebrex is the only one left on the market in the United States — increase the risk of heart attacks and strokes. New evidence has emerged that some other painkillers also increase the cardiovascular risks.
The most striking recommendation is that pain treatments should start with nonmedicinal approaches, such as physical therapy and exercise, weight loss to reduce stress on joints, and hot or cold packs. Only if those don't provide enough relief should drugs be used, and the doctor should take a step-by-step approach.
The first medication would usually be acetaminophen or aspirin at the lowest effective dose, or certain other low-risk drugs. Only if those fail should doctors progress to riskier drugs, starting with naproxen and then perhaps ibuprofen, both available over the counter. A cox-2 inhibitor should be prescribed only as a last resort.
The overall message is that one should use the lowest effective dose of the safest drug for the shortest period of time. That is always good advice, but it tends to be forgotten in an age when drugs are so heavily promoted.
posted by Carlos T Mock @ 8:56 AM
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