You are an active tennis player but cannot return to the court since you sprained your ankle. Or perhaps you have battled osteoarthritis in your knees for the past few decades. Maybe rheumatoid arthritis causes crippling joint pain in your mother’s hands. What can you do about the pain?
Only 5 years ago doctors, patients, and the pharmaceutical industry thought they had discovered the “magic bullet” – so called COX-2 inhibitors such as Vioxx and Celebrex. This new class of medication held a theoretical advantage over traditional anti-inflammatory medications in that they were less likely to cause damage to the lining of the gastrointestinal tract. This was a major problem of the old pain medications such as ibuprofen, naproxen, and diclofenac. Ingestion of these older drugs in high doses in as little time as one week was shown to cause stomach ulcers and often serious complications such as GI bleeding.
So drug companies designed multiple trials to show that COX-2 inhibitors gave adequate pain relief without the dangers of GI side effects. The pharmaceutical industry even started to investigate whether these wonder drugs could prevent such maladies as colon cancer.
Unfortunately, what these trials showed was that yes, COX-2 inhibitors decreased the risk of GI bleeding, but at the significant cost of increased incidence of heart attacks and death. This unexpected finding made headline news when announced a few years ago and led to the FDA’s removal of all but one COX-2 inhibitor from the market and left the remaining drug, Celebrex, with a dreaded “black box” warning. Thus, both patients and their doctors were left to figure out how to manage their debilitating pain.
Over the past few years, clinical researchers have conducted their own clinical trials to determine the optimal way to provide GI protection while delivering the needed pain relief. While no formal recommendations from the government have been made, several medical societies have put forth their own consensus guidelines.
In general, the use of a proton-pump-inhibitor (PPI), a medication that is extremely effective in reducing the strength of acid produced in the stomach, along with a traditional non-steroidal anti-inflammatory agent, is safe for patients at high risk for GI bleeding. COX-2 inhibitors appear to be safe for short-term use in patients with a low risk for heart disease. Most importantly, talk to your doctor about your use of any prescription or over-the-counter anti-inflammatory drugs and your risk of GI and cardiovascular side effects.
Before you know it, you will be back on the tennis court, the pain in your knees and ankles will be gone, and your mother’s hands will be pain free!