According to new guidelines by the American Heart Association, patients being treated for chronic pain are advised to avoid taking all nonsteroidal anti-inflammatory drugs (NSAIDs) drugs—at least at first—because of the increased risk of heart attacks and strokes posed by these medications.
Strong evidence has linked the use of NSAIDs (other than aspirin) with severe cardiovascular complications that could lead to lifelong injury or death. Researchers say that if 100 patients who have suffered a previous heart attack or are at risk for heart disease use NSAIDs for 12 months, six of them will die.
Cox-2 Inhibitors
The guidelines issued by the heart association expressed special concern over Cox-2 inhibitors, a subgroup of the NSAIDs class of drugs. At one point drugs such as Vioxx, Bextra, and Celebrex were thought of as wonder meds that could relieve pain and inflammation without causing stomach complications. However studies found that they significantly increase the risk of heart attacks and stroke. Currently, the only Cox-2 inhibitor on the market in the U.S. is Celebrex.
The step-by-step approach laid out in a statement by the American Heart Association is completely different from how doctors usually approach treating patients with chronic pain and inflammation.
“In the past, many physicians would prescribe the Cox-2 drugs first,” said Elliott Antman, professor at Harvard Medical School and lead expert appointed by the heart association to study the topic. “We are specifically recommending that they should be used as a last resort.”
New Approach to Treating Pain
According to the new guidelines, patients should first be treated with non-medicinal therapies including heating pads, ice packs, physical therapy, orthotics, and weight loss. If those measures provide no relief, medicinal therapy can be considered, but drugs should be tried in a specific order.
“In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs,” the statement said.
The next step is naproxen, and patients who need more relief can then move up to nonprescription painkillers like ibuprofen. After these options have been exhausted, Cox-2 inhibitors may be considered.
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