Celebrex? Vioxx? Can My Doctor Provide Me With Safe Pain Relief?
By Ian Mason
The news has been full of the recent FDA findings
on a new set of drugs to help relieve pain. These drugs have been
approved for re-release, but it is unclear whether Vioxx will be available
again and whether physicians will feel comfortable prescribing Celebrex
and Bextra for many of their patients.
What happened to these drugs?
Celebrex, Vioxx, and Bextra are all non-steroidal
anti-inflammatory drugs (NSAIDs, pronounced en-said-z), similar to
drugs like ibuprofen and naproxen, that are available over the counter
(OTC).
Celebrex, Vioxx and Bextra, (sometimes called Cox-2
inhibitors) however, use a slightly different method to achieve the
same effect as their OTC cousins; this new method was supposed to
limit the side effects some people experience on OTC drugs, including
stomach and intestinal problems and allergic reactions.
It was thought that because these drugs were less
likely to cause such problems, they might be safer for patients with
painful chronic conditions (like arthritis) to use for long periods
of time.
Unfortunately, some studies of Cox-2 inhibitors suggest
that while they don’t cause the sorts of side effects of other NSAIDs,
they may create a greater risk of myocardial infarction (heart attack)
or stroke.
For people already at risk for these diseases (including
those who have already experienced a stroke or heart problem), taking
these drugs over the long run may significantly increase the risk
of heart problems.
Now what do I do?
Until a final decision has been made on each of these
drugs, what can your healthcare provider do to help you with pain
management? Here are important pieces of information to think about
in determining what next steps to take:
* The Cox-2 inhibitors were not shown to be more effective
than other NSAIDs, like naproxen. If you’ve been on or thinking about
trying Vioxx or another Cox-2 inhibitor, you may be able to use an
older anti-inflammatory drug. Naproxen, one of the older NSAIDs, may
be an anti-inflammatory drug that actually lowers heart attack risk.
* Some people started on a Cox-2 inhibitors because
they had a stomach ulcer or other risk factors for stomach or intestine
bleeding (for example, people on blood thinners), which may be made
worse by older anti-inflammatory drugs. For some people who are at
risk for bleeding, other options like acetaminophen may be an option.
* There are lots of other medical options. Steroids
can be used for shorter periods of time to manage inflammatory pain
from diseases like arthritis and lupus. Opioids (drugs that resemble
opium), such as oxycodone, codeine, and hydrocodone (Vicodin) can
help with pain management, but they can have serious side effects,
and some of them can be addictive, so working closely with your healthcare
worker is key to determine if these will work for you. In addition,
some antidepressants may help with chronic (long-term) pain, though
the way this works isn’t yet known
* New procedures may be of assistance to you. Nerve
block therapy (in which certain nerves are temporarily anaesthetized)
can relieve pain temporarily. “Implantable “technologies, like spinal
cord stimulation (SCS) systems and implantable drug delivery systems,
do seem to help some people for whom other pain relief methods don’t
work.
* If you aren’t getting the relief you need (with
or without the use of Cox-2 inhibitors), you may want to consult a
pain specialist. Some large hospitals (such as Stanford University)
have departments devoted to pain management. The American Board of
Pain Medicine and the PainConnection (at painconnection.org) can help
you locate a pain specialist who can work with your other healthcare
professionals to put a new treatment plan together for you.
Harris, G., “F.D.A. Official Admits 'Lapses' on Vioxx,”
New York Times, March 2, 2005
Krames, E., “Implantable Technologies: Spinal Cord
Stimulation and Implantable Drug Delivery Systems,” http://www.painconnection.org/
Winfield, J. et al “A Primer on Pain Management: Optimal
Therapy for the Patient in Pain,” Medscape CME, February 2005.
Ian Mason, owner of Shoppe.MD Online
Pharmacy
Ian studies health, weight loss, exercise, and
several martial arts; maintaining several websites in an effort to
help provide up-to-date and helpful information for other who share
his interests in health of body and mind.
Contact Ian Mason by e-mail at ian@shoppe.md.
