Anti-inflammatory Medication (NSAIDS) for Knee Pain

3d render of top view of medical pills stack

Overview

These are commonly used and can be purchased over the counter.  They help reduce pain and inflammation.  Acetamin (brand name Tylenol) can also be helpful in reducing pain but has no anti-inflammatory properties.  Caution should be used with NSAIDs as they have been linked to potentially severe side effects, sometimes fatal, including gastric bleeding, kidney damage, heart attacks and stroke.

RESCU Treatment Ratings

R = Risk      E = Effectiveness      S = Self-Care

C = Cost     U = Usefulness (overall rating)

1 = Least Favorable     5 = Most Favorable

R

RISK: 2/5

The American Heart Association and other national and international organizations have warned about chronic use of NSAIDs particularly in patients with, or at risk of developing, cardiovascular disease.

Common side of effects of NSAIDs include nausea and vomiting, diarrhea and reduced appetite, upset stomach, mild heartburn. Other common side effects include bloating, gas, diarrhea, drowsiness, rash and headache, dizziness, constipation, nervousness, mild itching and ringing in the ears.

A common and potentially serious side effect of NSAIDS are gastric or peptic ulcers, which can lead to potentially fatal bleeding. NSAIDs can also cause kidney, liver, and cardiovascular side effects. Ibuprofen can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Do not use this medicine just before or after heart bypass surgery (coronary artery bypass graft, or CABG).

People with cardiovascular or kidney disease, prior heart attacks, prior stroke or history of peptic ulcer should avoid NSAIDs. Do not take more than your recommended dose. An ibuprofen overdose can damage your stomach or intestines. The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses). Use only the smallest amount needed to get relief from your pain, swelling, or fever.

The risk of death from bleeding attributed to NSAID/aspirin use is about 5.57% or about 21-25 cases per million people. Interestingly, up to one third of all deaths from NSAIDs/aspirin are from low dose aspirin. Many patients feel that over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) like Motrin, Aspirin and similar drugs are very safe, since they are so widely used. This study demonstrates that NSAIDS and aspirin carry a significant risk of injury, primarily from gastric bleeding, and death.

Source:

Am J Gastroenterol. 2005 Aug;100(8):1685-93. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti inflammatory drug use.

In reviewing data on the safety of aspirin and other NSAIDs in overdose fatality reports from the American Association of Poison Control Centers (AAPCC), the data indicate that ibuprofen in overdose is relatively benign and requires supportive and symptomatic treatment. However, acute overdose with aspirin and chronic aspirin toxicity (eg. salicylism) are associated with significant morbidity and mortality.

There are reported estimates of 100,000 hospitalizations per year in the U.S. for NSAIDS related gastrointestinal (GI) bleeding alone, and up to 16,500 deaths per year. Risks include gastric bleeding, cardiovascular problems and kidney problems. The cost for caring for these side effects is estimated at $4 billion dollars a year for the elderly alone, though they are not the only ones at risk. All NSAIDS have risks, and you are 2.5 times more likely to have an adverse GI event if you take NSAIDS than if you don’t. You have a 2.4 times greater risk of stroke and triple the risk of kidney failure if you take NSAIDS.

While the risks are greater the longer you take them and in higher doses, NSAID risks are there even if you use them for a short period of time. For some patients, the risks of GI injury can be reduced by taking a proton-pump inhibitor or misoprostol (which is also used to induce abortion.)

Source:

Fine M Quantifying the Impact
Chou Pharm Management of LB E

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