Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

7 Av 5763 - August 5, 2003 | Mordecai Plaut, director Published Weekly









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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

We continue with our discussion of pain. We were discussing NSAIDs, which are a family of pain relievers that include ibuprofen and naproxen, both of which are available without prescription in low doses. These medications relieve pain and reduce inflammation, as well as reducing fever. They are the drug of choice for pain from renal colic -- that is, kidney stones. However, in general they are mediocre pain relievers and offer no advantage over Acamol despite often being prescription drugs. They also come with risks of bleeding in the stomach and kidney failure, a problem mostly seen in middle aged and older patients, and those with congestive heart failure. They reduce fever very well. The fact that they reduce inflammation is not necessarily an advantage; the reduction of swelling is not at all related to pain relief, and may cause joint damage. They do have some anti-platelet (against clotting) effects like aspirin.

Often in this country, an injectable preparation of one of these drugs is used, called Voltaren or Arbitren. This injection is painful and the pain may last for a few days. It does not work any faster or better in injection as opposed to by mouth. Its pain-relieving qualities are akin to others in its class: modest.

The tendency of the medication to cause bleeding in the stomach has led to research to overcome this problem. The combination with drugs that reduce acidity in the stomach like Gastro or antacids does not help at all, although it is a cheap way of dealing with it. Second generation acid reducers such as Losec do help, but they are expensive for the health funds. A combination of Voltaren and a novel drug called Cytotec is very protective, but can cause diarrhea, as well as not being cheap and being contraindicated in pregnancy.

A new class of drugs called the COX2 have been introduced. Vioxx is the one most heavily marketed. These once-a-day drugs are expensive, but the orthopedists love them because they seem to cause less bleeding. However, they cause the same amount of kidney failure and the same degree of modest pain relief. They do not block clotting effects, so they increase the risk of heart attack and stroke. They cause water retention and leg swelling, as well as increases in blood pressure that may be dangerous for heart patients. I do not use this class of drugs. Write me in care of the Yated.

A message from GlaxoSmithKline, sponsor of this column. Who wants to talk about lice? These are difficult pests to eradicate in this country. Glaxo's product Lyclear is designed to help. We will speak on this subject, but there is hope.


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