It seems that every time we open a newspaper, we read about yet another danger from a popular pain reliever. Are there any safe options left to relieve our aches and pains?
The most widely used pain and anti-inflammatory medications are nonsteroidal anti-inflammatory drugs (NSAIDs), which include popular brands like Motrin and Aleve and the various brands of aspirin. There was much excitement when COX-2-selective NSAIDs were introduced about 7 years ago, because they were associated with less gastrointestinal bleeding, the most dangerous side effect of aspirin and some of the other NSAIDs.
By 2005, however, two of the most popular COX-2 drugs, Vioxx (rofecoxib) and Bextra (valdecoxib), were removed from the market because they significantly increased the risk of cardiovascular events.
A recent study has suggested that the cardiovascular risk of Vioxx may continue for at least a year after the drug has been discontinued, a finding that's led some heart experts to recommend "vigilant follow-up" for people who previously took this drug.
The remaining available COX-2 drug, Celebrex (celecoxib), carries a warning from the Food and Drug Administration (FDA) that it may raise the risk of cardiovascular events. The FDA has required that all other NSAIDs, including over-the-counter and prescription drugs, carry a warning of their potential for increasing the risk for cardiovascular events, as well as life-threatening gastrointestinal bleeding.
Aspirin, the one NSAID that protects against cardiovascular disease, carries the risk of intestinal bleeding.
All of these problems with NSAIDs have led many doctors to prescribe acetaminophen (Tylenol) as the drug of choice for pain. However, acetaminophen does not counter the inflammation of joint pain caused by disorders like rheumatoid arthritis.
Recently, a headline in Baltimore's Sun newspaper blared: "Tylenol linked to liver damage." Tylenol is one of the trade names for acetaminophen, which is also a component of a number of over-the-counter drugs for pain relief.
The headline is based on a study of healthy young subjects who took the maximum dose of acetaminophen (4 grams a day) for two weeks. More than one-third of them developed significant, but temporary, elevations in blood levels of a liver enzyme indicating liver damage.
Does this finding mean we should also be wary of taking acetaminophen? I think not. "Acetaminophen clearly has a remarkable safety record when taken as directed," say the authors of the study linking liver damage and high daily doses of the drug, "and chronic treatment with 4 g daily has been confirmed to be safe."
Despite the results of this study and the accompanying frightening news stories, acetaminophen remains the safest, albeit least potent, drug for the treatment of pain.
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