Doctors treating people for chronic pain should avoid using all medications -- at least at first -- the American Heart Association advised yesterday in guidelines designed to have a significant impact on the use of medications known as nonsteroidal anti-inflammatory drugs, or NSAIDs.
The scientific statement said that, with the exception of aspirin, there is now strong evidence that NSAIDs are associated with an increased risk of heart attacks and stroke. If 100 patients who have had heart attacks in the past or are at risk for heart disease take these drugs for a year, researchers would expect to see six additional deaths in this group. NSAIDs reduce fever, pain and inflammation.
The professional association laid out a step-by-step approach that is very different from the way physicians typically have approached treating chronic pain and inflammation.
"In the past, many physicians would prescribe the Cox-2 drugs first," said Elliott Antman, a professor at Harvard Medical School who led a group of experts assembled by the heart association to study the issue. "We are specifically recommending that they should be used as a last resort."
"This is a very firm statement we are making," he added. "It is our belief, hope and desire that physicians will take our advice, and by doing so it is our belief and hope that we will reduce the number of patients who suffer heart attacks and strokes."
Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.
Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:
"In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs."
Courtesy Washington Post
Bonnie - wow...these are huge comments coming from the American Heart Association. I was very encouraged by them stating that nonmedicinal measures should come first. However, I did not see food mentioned as a pain trigger. Until this is realized, there are going to be some very frustrated doctors who are going to have quite a time trying relieve pain in their patients without the standard medical "crutches." We would all have a much better time of it if we recognized that some food causes pain.
1 comment:
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