Fitness Files: More on the use of NSAIDs

“WHAT???” My friend emailed me after last week’s column about the risks associated with common pain relievers. “I thought my daily aspirin prevented heart attack!”

Like so many medication questions, good sense is the best answer, and finding the comforting guaranteed absolute is a pipe dream.

Let’s consult MayoClinic.org‘s “Daily Aspirin Therapy: Understand the Benefits and Risks.”

Many articles including Mayo’s are full of admonitions to consult your doctor.

I’ll tell you what I have learned, but keep in mind that blanket instruction.

If you’ve had a heart attack or stroke, stent or bypass, taking daily aspirin is supported by studies. Likewise for diabetes, smoking, high blood pressure and if you’re 50 to 59 years old. More research is needed for those younger than 50 and older than 70, with the ubiquitous “consult your doctor” for those between 60 and 69.

Why is the daily aspirin recommended for the specific population above? You probably know that it interferes with blood’s clotting action, therefore lessening the chances of a clot blocking an artery, causing heart attack or stroke. “Very low doses …75 milligrams … can be effective,” Mayo says.

I rushed a response to a second friend who had a heart attack, read my article and decided to take an “aspirin holiday.” Do not suddenly stop taking aspirin! Mayo warns of the “rebound effect that may trigger a blood clot.”

So if you’re in one of the above cited groups, the aspirin risk of stroke from bleeding, gastrointestinal bleeding and allergic reaction still apply, but Mayo seems to think that the benefits outweigh these risks. Drug interactions occur, so discuss with your pharmacist or doctor. And limit daily alcohol intake to one drink for females and two for males.

If you have no history of gastritis or ulcers, skip the enteric coated aspirin — Mayo says there is no evidence that it decreases gastro-bleeding, and it may not be the most effective during a suspected heart attack.

OK, what about the rest of us?

WebMd.com‘s “Are Anti-Inflammatory Pain Relievers Safe for You?” opens with, “There is no question that the risks of NSAIDs can be serious, even life-threatening … with side effects hospitalizing over 100,000 and killing 16,500 in the U.S.”

After getting the “risks” elephant out of the closet, the reality is that “chronic pain is terrible in itself …destroying people’s lives. NSAIDs can be a valuable treatment,” it says.

Classes of NSAIDs (non-steroidal anti-inflammatories) and prescription Cox-2 inhibitors “work to block the effects of chemicals that increase the feeling of pain and reduce swelling” of whatever hurts, but regrettably they are “likely to cause a different reaction somewhere else, too.”

So relieving pain for the “occasional headache or backache is probably safe,” but the bigger risks are for people who take NSAIDs for the long term, it says.

“More than half of all bleeding ulcers are caused by NSAIDs,” a problem circumvented by taking the Cox-2 inhibitor, but their real downside is the increased risk of heart attack, stroke and serious skin reactions. Cox-2 inhibitors are prescriptions, but all over-the-counter NSAIDs can cause high blood pressure and kidney damage.

Yet, WebMd goes on to say that the “focus on the side effects has made people lose confidence in a very valuable category of drugs.” And non-NSAID “painkillers have their own drawbacks.” Tylenol does not reduce inflammation, and prescription narcotics like OxyContin, Percocet and Vicodin can be addictive.

I set out to explain that NSAIDs are necessary pain killers and ran into even more warnings. As WebMd says, “Trying to sort through the benefits and risks of NSAIDs can be bewildering.”

However, here’s what seems to be good sense regarding NSAID use:

•Short term is best

•Long-term use needs doctor’s consultation. “People respond better to certain NSAIDs,” although nobody knows why. A pharmacist, available without appointment, could be a valuable consultant.

•Read the label, and do not take more often than recommended or a greater dose.

•People with multiple conditions should resist the impulse to grab an over-the-counter pain killer without careful medical consultation. WebMd says, “If you’re seeing a number of experts, you might be getting a lot of contradictory advice. Cardiologists … focus on the risks. Rheumatologists ... tend to focus on the benefits…. The correct medicine requires a careful balancing act.”

•Take a bag of all your meds to every doctor’s appointment. Demand analysis of interactions.

•WebMd adds, “Patients should also look for techniques to reduce pain that don’t rely on medication — like biofeedback, acupuncture, hypnosis and yoga.” Depending on your condition, physical therapy, exercise and weight loss — if you’re overweight — can also improve your symptoms.

I wish I could offer my readers specifics: Take this, not that, for “X” days. I dislike ambiguity, yet here is the service I hope I provided: Everyone has bottles of common pain relievers. Few think about risks of grabbing a bottle and swallowing. Magic. They work so often.

Appreciate their help, but do not assume they are 100% safe just because they’re commonly used.

They’re not.

Newport Beach resident CARRIE LUGER SLAYBACK is a marathoner in her 70s who brought home first places in LA Marathons 2013 and 2014 and the Carlsbad Marathon 2015. She lives in Newport Beach.