Effectiveness of pain medications

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It is common in my West Seattle Chiropractic Clinic for patients to tell me they’ve been taking Ibuprofen, Tylenol, Aleve or other over the counter medications for their pain (NSAIDS), but it doesn’t seem to be helping.  They also say that after a few doses they start having stomach problems.

A meta-analysis of randomized, placebo-controlled trials comparing the efficacy and safety of NSAIDs with placebo for spinal pain concludes that among 6,065 spine pain patients, "NSAIDs reduced pain and disability, but provided clinically unimportant effects over placebo."

The authors also calculated that "compared with placebo, NSAIDs do not provide a clinically important effect on spinal pain, and six patients must be treated with NSAIDs for one patient to achieve a clinically important benefit in the short-term."  In other words, 1 out of 6 get a little relief. 

In the paper's final paragraph, the authors conclude, "When this result is taken together with those from recent reviews on paracetamol and opioids, it is now clear that the three most widely used, and guideline-recommended medicines for spinal pain do not provide clinically important effects over placebo."

All NSAIDs have been associated with cardiovascular and gastrointestinal risks.  Common side effects are: stomach upset or nausea, stomach pain, heartburn, and diarrhea.

Less common but potentially serious side effects of NSAIDs include: stomach ulcer and bleeding, increased blood pressure, and allergic reaction -- hives, facial swelling, asthma/wheezing.

Herbal remedies have been suggested as effective non-pharmaceutical alternatives because of their relatively low incidence of side effects. Extracts of the bark of willow (Salix) species have been used to treat numerous conditions, including fever, mild rheumatic complaints, and pain such as mild headache; it is widely known that aspirin is a concentrated derivative of this plant, but the plant is without the side effects.  Unfortunately very few studies have been done about the effectiveness of these herbal medicines.

It is conservatively estimated that 16,500 nonsteroidal anti-inflammatory drug (NSAID) deaths occur among rheumatoid arthritis or osteoarthritis patients every year in the U.S.  This is a disturbingly high number for drugs that people consider fairly harmless.

Using any medications while in pain can mask the symptoms, but do not address the cause of pain.