Monday, April 11, 2011

Osteoarthritis and Anti-Inflammatories - What Are the Risks? Are There Any Alternatives?

Do you suffer with Osteoarthritis?

If so, do you self medicate with over-the-counter medication? Have you been doing that for a while or whenever you experience a "flair-up" in your condition?

Well, this is going to be an important article for you to read, as you may be interested in the short-tern and long-term effects of taking these medications. Most of these medications are over-the-counter "NSAIDS" and may have some serious consequences.

Another important topic to discuss as a side note is why you may be having a flair-up in the first place, but let's safe that for another time.

What are the effects of Non-steroidal Anti-Inflammatory Drugs (NSAID's)?

Swedish physiologist Ulf Von Euler discovered a biologically active compound he named "prostaglandin" in 1935. He named it that, since he believed it was made by the prostate gland.

However since women also have prostaglandins in their body (but no prostate), it is known that this compound is manufactured in tissues all over the body.

Fast forward to 1971. Again, researchers from Sweden found that "aspirin-like" drugs could reduce the production of prostaglandins. Was this important you ask, and if so why was this important?

Well, It was important enough for these scientist to receive the Nobel Prize in Physiology in 1982 for their work on prostaglandins.

The summary of the official Nobel Prize press release for their research goes basically as follows: When the body undergoes stress, trauma and/or disease (like Osteoarthritis), a release of prostaglandins occurs.

Their work also determined what prostaglandins were made up of. That is, prostaglandins are formed from unsaturated fatty acids, primary one called "arachidonic acid"

So we know the people at Nobel felt that their work was important enough for a prize, but let's see why, and what that means to you and your pain.

Well, when we have stress, trauma and disease, we know that we have this prostaglandin release from the cells. This can also be though of as INFLAMMATION. It is known that where we have inflammation we also have pain.

So when the researchers discovered that "aspirin-like" drugs reduces production of prostaglandins in response to stress, trauma, and disease, in effect, they discovered a way to reduce our inflammation, and subsequently, our PAIN. These drugs, then became known as NSAIDS, or Non-Steriodal anti-inflammatories. (As, it they are not Steriodal based drugs)

Until that discover, drugs like Aspirin were hardly understood in terms of how they worked. So this became a very important discovery. Unfortunately, what also became understood were the "side-effects".

NSAIDs Risks:

Cardiovascular risks increased, gastrointestinal bleeding risk increased, and increases in kidney damage. Alzheimer's and dementia risks increased as well.

Kidney Disease: Extensive studies should bring about a very real concern for those that take large amounts of NSAIDS. As an example, is the New England Journal of Medicine, Dec 22,1994, #25, Vol331:1675-1679. In this study, researchers concluded that:

"people who take analgesic drugs frequently may be at increased risk of end stage renal disease (ESRD), but the risk remains unclear".

Basically in that study 716 patients treated for ESRD and 361 control subjects. Those in the study group took dosages of 5000mg or more pills containing NSAIDs. Sadly, they had an increased risk of ESRD by 780% compared to the control.

Gastrointestinal Bleeding: Again in the New England Journal of Medicine, this time June of 1999, researchers found that there was endoscopic proof that aspirin could cause gastric muscosal damage. This has been substantiated by a lot of other studies as well.

What's scary about that is the fact that NSAIDs have more than 70 million prescriptions and more than 30 billion over the counter tablets sold annually in the US.


Another startling finding is that those same researchers state:

"it has been estimated conservatively that 16,500 NSAID-related deaths occur among patients with rheumatoid arthritis or osteoarthritis every year in the United States"

As well, if the total amount of people dying from gasto-intestinal toxic side effects of NSAIDs were calculated separately in the National Vital Statistics report, would rank as the "15th most common cause of death in the US".

Probably the most alarming part of all of that is the fact that these dangerous side-effects remain largely a 'silent killer'.

Even doses of aspirin as low as 30mg are enough to reduce prostaglandin production in the gastric mucosa, thus starting the onset of gastric-duodenal mucosal injury.

Cardiovascular Events: You've probably heard of drugs such as Vioxx, Celebrex, or Bextra? Maybe you've even taken them, or are still taking them.

These drugs are known as "Cox-2 inhibitor", and were taken off the market because of the evidence of "unacceptable risk of cardiovascular events".

Well, there was a study done in the European Heart Journal July 2006;27(14):1657-63.

These researches studied the risk of myocardial infarction related to the use of various NSAIDs in the general population. They authors found that the use of NSAIDs were related to modest risk of first time Myocardial infarction

Dementia, including Alzheimer's disease:

Another study, this time in the journal Neurology (April 22, 2009) found risk with taking NSAIDS.

These authors studied 2736 elderly considered not to have dementia. They studied this subjects for up to 12 years to identify dementia and Alzheimer's disease(AD).

These authors concluded: "contrary to the hypothesis that NSAIDs protect against AD, pharmacy defined heavy NSAIDs users showed increased incidence of dementia and AD, by 66%"

In that study, the basic daily dose of prescription ibuprofen was defined as 1,200mg/day (2- 600mg/day).

IF in that study, the subjects were only taken 1200mg, and had increased risk of dementia and Alzheimer's and you're a regular ibuprofen taker, compare it to your dosage. You might be a little alarmed at this point.

If you have alot of pain, have suffered with Osteoarthritis for years, and happen to take NSAIDs on a daily, weekly, or monthly basis, you really need to consider the risks and come up with an Alternative Approach.

A Natural Pain Relievers For Osteoarthritis Pain

Fish oils (omega fatty-acids).

Fish oils contain omega-3 polyunsaturated fatty acids, including the 20 carbon long oil eicosapentaenoic acid, or EPA.

EPA has an advantage over NSAIDs in that it reduces both the COX and LOX enzymes, that in turns reduces the production of Prostaglandin E2(PGE2) and Leukotriene B4(LTB4).

As a result, the inflammatory cascade is reduced which results in reduced pain. But most importantly, the risk if kidney problems, GI problems, Cardiovascular problems, and Dementia Problems are ALL reduced too.

An incredible Study was conducted in the journal Surgical Neurology 65(April 2006) 326-331.

That particular paper won first prize at the American Association of Neurological Surgeons Annual Meeting. The paper was entitled:

"Omega-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain"

The researcher Dr Joseph Maroon is from the Department of Neurological Surgery, University of Pittsburgh Medical Center.

Dr. Maroon studies how the use of NSAIDs is related to occasional extreme complications including: "gastric ulcers, bleeding, myocardial infarction, stroke, and even death".

In Dr. Maroon's research, he explained after 75 days on high dose fish oil:

"59% of patients with chronic spinal pain and who had degenerative spine disease were able to discontinue their prescription NSAIDs, and 88% stated they were satisfied with their improvements and that they would continue to take fish oil"

In summary, for decades it has been known that taking NSAIDs is associated with undesirable and potentially fatal side effects. Fish Oil as well as a specifically designed rehab program to increase spinal flexibility can both be beneficial to individuals suffering from chronic spinal pain syndromes, such as Osteoarthritis.

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