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As far as medical emergencies go, this one was pretty straightforward, at least. I sped to the hospital in an Uber on a clear early morning, my 18-year-old daughter sobbing next to me and puking into a plastic bag. Three days earlier, she had undergone surgery to remove her wisdom teeth. Now her insides staged a violent rebellion. The source of her pain? Her pain reliever herself, in the form of a bottle of prescription ibuprofen.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used drugs in the world. They relieve pain by blocking the production of the enzyme cyclooxygenase. This process, in turn, inhibits the production of prostaglandins, resulting in less swelling and inflammation. You probably have several over-the-counter and prescription NSAID varieties in your medicine cabinet right now – aspirin, ibuprofen, naproxen, celecoxib. They’re what you reach for when menstrual cramps hit, you overdo it at the gym, your arthritis flares up, or your back pain flares up. Robert H. Shmerling, MD, writing for Harvard Health in 2020, reported that approximately “15% of the US population regularly takes an NSAID (including those who are over-the-counter and prescription-strength)” along with “sporadic users ‘ adds up to ‘more than 30 billion doses…taken each year’.
Most of the time, taking NSAIDs is a good thing. Adequate medication means you don’t miss days at work or school. It means being able to participate in valued activities. There is even now a growing body of research into the use of NSAIDs in patients to combat the opioid epidemic. With one in five of us living with chronic pain, managing it effectively is a serious concern — and a fundamental right.
NSAIDs can upset your stomach harder than you ever imagined.
But NSAIDs can be hard on your stomach – harder than you ever imagined. Speaking to the Mayo Clinic News Network in 2018, family doctor Dr. Summer Allen that “one of our biggest concerns about NSAIDs for patients is that it can cause bleeding in the GI, stomach lining, or gastrointestinal tract.” This can be especially risky for people who use them regularly or long-term . The Canadian Society of Intestinal Research estimates that “15-30% of long-term users of NSAIDs are at risk of developing ulcer disease, with 2-4% of those ulcers leading to complications.”
Where things get even trickier – such as For example, sitting on a stretcher connected to an IV line for 12 hours is tricky — is the ever-expanding realm of adverse drug interactions, comorbidities, and overprescribing. Consumer Reports notes that “more than half of us now take prescription drugs regularly — four on average.” And they don’t all play well together.
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Are you one of the 20 million or so Americans who take antidepressants? A 2021 study from Creighton University School of Medicine found that for patients already taking NSAIDs, adding SSRIs meant “the likelihood of developing upper gastrointestinal bleeding increased by 75%.”
Do you take blood thinning medications, ACE inhibitors, beta blockers or other NSAIDs? All of these combinations can cause stomach irritation or other side effects.
Do you have Crohn’s disease? NSAIDs can make your symptoms worse.
Are you over 65? More than a decade ago, a study in the Journal of the American Medical Directors Association warned that chronic NSAID use “increases the risk of peptic ulcer disease, acute kidney failure, and stroke/myocardial infarction” in the elderly.
When we heard the word “gastritis” she had already been in the hospital for half a day.
But even for the otherwise perfectly healthy, there are important considerations to understand before taking NSAIDs. A 2016 report in the British Journal of General Practice warns, “From day one of use, all NSAIDs increase the risk of gastrointestinal bleeding, myocardial infarction and stroke.” And pointing to yet another example of the boomerang effect Research from Canada published just last month suggested that “taking drugs like ibuprofen and steroids to relieve short-term health problems could increase your chances of developing chronic pain.”
My daughter was already taking two prescription drugs including the NSAID naproxen at the time of her oral surgery. After her procedure, she came home with two more Prescriptions – one for ibuprofen and one for antibiotics (which can also lead to stomach issues like diarrhea, cramps, and even C. diff infections in some cases). Looking back, it’s fortunate that she didn’t react worse than she did to everything.
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Her symptoms did not appear to be NSAID related at first. They didn’t seem to be of the digestive system nature at all. Her initial complaint was severe back pain, which was soon followed by stomach pain. As it moved to her abdomen, she vomited. When we heard the word “gastritis” she had already been in the hospital for half a day.
My daughter’s experience was anything but unusual, even within my own family. Three years ago, while my older daughter was on medication and recovering from an autoimmune issue, she got a brand new gastroenterologist for all the NSAID side effects she was developing on top of that. The American Journal of Medical Care estimates that “11% of preventable drug-related hospitalizations could be attributed to NSAIDs,” noting that some figures put the annual number at “more than 100,000 patients hospitalized for NSAID-related GI complications alone.” be admitted to the hospital”.
So what can you do to break the cycle of pill popping and stomach pain? First, weigh the risks and opportunities. Talk to your doctor about this Everyone the medications you are taking, including over-the-counter medications, before any new procedure or prescription. If you are in pain, don’t go with a “more is more” attitude and exceed the recommended dosage. A 2018 Boston University study found that about “15 percent of adults taking ibuprofen or other NSAIDs have exceeded the maximum recommended daily dose for those drugs … increasing their risk of serious side effects like internal bleeding and heart attacks.” Take your NSAIDs with food and avoid irritants like alcohol. And don’t hesitate to consult your doctor or go to the hospital if you have serious and persistent symptoms.
“The best way to avoid complications from NSAID use is to talk to a doctor. If you’re in pain for more than three days, you should be evaluated and evaluated to determine what the underlying cause of the pain is,” said Ashley Allen of Allen Health & Wellness, a pain management nurse. “Often there are other, more appropriate drugs that can be given to treat a condition. For example, if someone has a sinus headache, it may be best to treat them with antibiotics to treat infection or with an antihistamine to reduce swelling. no NSAID. For some individuals, it may be appropriate to also take a proton pump inhibitor such as Prilosec (omeprazole) to protect the stomach lining from damage.”
My daughter is lucky. She is young and strong; She has recovered well from the oral surgery herself. During her surprising trip to the hospital, she received excellent and thorough care, with no other underlying illnesses being identified. But her heart is still recovering from the flamethrower effects of her recent experience, and her doctor has put her on a bland diet of small meals for two months. It’s no small thing to actively resist pain for so long.
And it’s a chronic problem for many of us, casually gulping through bottle after bottle of ibuprofen and soon after being chased by bottle after the inevitable bottle of Pepto Bismol. I don’t think it’s any coincidence that a list of America’s best-selling over-the-counter drugs by the Consumer Healthcare Protection Association places oral analgesics at the top of the list — with heartburn cures right behind it.
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