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.
