Taking Two Different NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used, among other things, to treat the pain and inflammation of arthritis. Because arthritis and musculoskeletal injuries are so common, NSAIDs are one of the most commonly prescribed medications worldwide. In addition to prescription NSAIDs, many also are available over the counter in pharmacies, grocery stores and discount chains.

Because these effective drugs are so readily available, some people with arthritis may take both prescription and over-the-counter (OTC) NSAIDs at the same time – either purposefully or without realizing it. All NSAIDs come with a risk of serious gastrointestinal events, such as the development of bleeding ulcers, and taking multiple NSAIDs can increase that risk.

What Problem Was Studied?

A team of scientists – led by Arthritis Foundation-funded researcher Stacey H. Kovac, PhD, of Durham VA Medical Center and Duke University in Durham, N.C. – hypothesized that people may take more than one NSAID for two possible reasons. One would be to obtain pain relief when the treatments prescribed by their health-care team are inadequate. The other would be because the people are unaware that the two medicines they are taking come from the same therapeutic class.

The research team sought to determine how many people take more than one NSAID and whether dual use of NSAIDs is related to the person’s quality of life. The theory being that inadequate pain control may be reflected in poor scores on health-related quality of life measures.

What Was Done in the Study?

The study was conducted at the University of Alabama at Birmingham under the guidance of Arthritis Foundation award recipients Kenneth G. Saag, MD, MSc, and Jeffrey R. Curtis, MD, MPH. Of 424 people identified through another clinical trial, 138 completed all the paperwork and had enough data for analysis. These people answered questions on demographic and economic factors, over-the-counter NSAID use and prescription NSAID use; participants also completed a health survey.

What Were the Study Results?
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Thirty-six (26 percent) of the 138 participants were dual users of NSAIDs – meaning they took two OTC, two prescription or one of each NSAID several days per week. Dual users were more likely not to have arthritis than single users. Dual use was found to be associated with lower scores on the health survey, meaning that participants taking more than one NSAID had poorer health-related quality of life. This could indicate that these people are seeking relief from inadequate pain management by the health-care team.

What Does This Mean for People With Arthritis?

Study authors conclude in their article that it is important to find out why some people use more than one NSAID and determine ways to identify those people because they may be at a higher risk for NSAID-related toxicity. Kovac states, “If inadequate pain management is a contributing factor, then identifying more appropriate pain management strategies that are less likely to cause adverse events is needed. Adequate pain management may have the potential to reduce dual use, improve patient symptoms, including physical functioning, and reduce patient safety problems.”

If you have arthritis and your pain is not being relieved by the methods you currently use, speak to your doctor about your alternatives. Heat and cold therapies, relaxation techniques, splinting and the combination of an NSAID with acetaminophen are safe treatments that can help relieve your pain without increasing your risk of serious gastrointestinal problems.

Kovac SH, Saag KG, Curtis JR, Allison J. Association of health-related quality of life with dual use of prescription and over-the-counter nonsteroidal antiinflammatory drugs. Arthritis Care Res 2008;59:227-33.

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