NSAIDS Archives - Mayo Clinic News Network

Science Saturday: Opioids provide low evidence of pain relief for migraine

Adam Harringa — Sat, 28 Aug 2021 06:00:00 +0000

Evidence that opioids provide pain relief for migraine headaches is low or insufficient, a large Mayo Clinic meta-analysis published recently in JAMA has found. However, some newer therapies, along with established migraine treatments, were associated with moderate to high evidence of pain relief.

The meta-analysis – which combined results from multiple scientific studies – included 15 systematic reviews and 115 randomized clinical trials of 28,803 patients. While the researchers note that this study provides a good starting point for treatment conversations between patients and providers, many patients respond differently.

“Choosing a treatment for migraine attacks requires an individualized approach for each patient,” says lead author Juliana VanderPluym, M.D., Mayo Clinic neurologist. “Living with migraine can be challenging, and sometimes debilitating, for millions of people worldwide.”

Migraine headaches can cause severe throbbing pain or a pulsing sensation, usually on one side of the head, often accompanied by nausea, vomiting, and extreme sensitivity to light and sound. A migraine usually lasts from four to 72 hours, if untreated. About 12% of people worldwide suffer from migraine, including 18% of women, according to the Migraine Research Foundation.

The study found that triptans, NSAIDS (nonsteroidal anti-inflammatory drugs such as aspirin, diclofenac, ibuprofen and ketorolac), or a combination of the two provided the largest evidence-base for relief at two hours, as well one day after symptoms began. Two newer treatments recently approved by the Food and Drug Administration (FDA), ubrogepant and rimegepant, had moderate to high strength of evidence and mild side effects. Lasmiditan, another new therapy, also had a high strength of evidence, but also was associated with a significant risk of adverse events.

Among devices, external vagus nerve (located at the side of the neck) stimulation and remote electrical neuromodulation (located over the arm) each had moderate strength of evidence. External trigeminal nerve (located over the brows) stimulation and transcranial magnetic stimulation (located over the back of the head) showed slightly less strength of evidence.

Read the rest of the article on Advancing the Science blog.

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Other Mayo Clinic medical research websites:

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Chronic pain and medication decisions

Dana Sparks — Wed, 23 May 2018 20:00:19 +0000

Chronic pain can limit your quality of life and lead to additional health problems. Finding treatment is important, as is balancing pain relief with your safety.

Like any long-term health problem, chronic pain often leads to complications beyond your physical symptoms, such as new or worsened depression, anxiety and difficulty sleeping. The condition can make it more difficult to keep up at work, manage tasks at home and attend social gatherings. This could lead to problems in your relationships and financial instability.

The consequences of chronic pain make finding effective treatment critical. But this process is complex and personal. What works for one person's chronic low back pain may not relieve your osteoarthritis. Your diagnosis, biology and personal history all play a role, and finding pain therapies that bring you adequate relief can be a lengthy effort.

Working in partnership with your health care provider, however, you can identify treatments that enable you to live an enjoyable, fulfilling life. The approach you choose should include more than just medication, but painkillers are likely to play a role. Learn about the risks and benefits of common pain medications, so that you can make safe choices as you seek your solution.

Nonsteroidal anti-inflammatory drugs (NSAID)

NSAIDs are most effective for mild to moderate pain that's accompanied by swelling and inflammation. These drugs commonly are used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.

Generic (brand) names
NSAIDs include ibuprofen sold as Advil and Motrin IB as well as other names, and naproxen sodium, sold as Aleve.
How they work
NSAIDs work by inhibiting certain enzymes in your body, called cyclooxygenase, that are released during tissue damage. By blocking the different types of cyclooxygenase (COX), including COX-1 and COX-2, NSAIDs can reduce pain and inflammation resulting from an injury.
Benefits and risks
When taken as directed, NSAIDs are generally safe. But if you take more than the recommended dosage — and sometimes even just the recommended dosage — NSAIDs may cause nausea, stomach pain, stomach bleeding or ulcers. Large doses of NSAIDs also can lead to kidney problems, fluid retention and high blood pressure. Risk of these conditions increases with age and in the presence of other health problems, including diabetes, a history of stomach ulcers or reflux, and kidney disease.
Bottom line
If you regularly take NSAIDs, talk to your health care provider, so that he or she can monitor you for possible side effects. Bear in mind that NSAIDs also have a "ceiling effect." That is, there is a limit as to how much pain they can control. Beyond a certain dosage, they don't provide additional benefit. Exceeding the recommended dose may not relieve your pain and may increase your risk of side effects.

Watch: Mayo Clinic Minute - Avoids opiopids for chronic pain.

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

Acetaminophen

Acetaminophen usually is recommended as a first-line treatment for mild to moderate pain, such as from a skin injury, headache or musculoskeletal condition. Acetaminophen often is prescribed to manage osteoarthritis and back pain. It also may be combined with opioids to reduce the amount of opioid needed.

Brand names
Acetaminophen sold as Tylenol and under other names.)
How it works
Scientists don't know exactly how acetaminophen works. Some believe there may be a third type of cyclooxygenase, COX-3, that acetaminophen blocks. Acetaminophen doesn't affect the other two cyclooxygenase enzymes, and it doesn't target inflammation — only pain. It may be less effective than NSAIDs.
Benefits and risks
Acetaminophen generally is considered safer than other nonopioid pain relievers because it doesn't cause side effects such as stomach pain and bleeding. However, taking more than the recommended dose — or taking acetaminophen with alcohol — increases your risk of kidney damage and liver failure over time.
Bottom line
Acetaminophen is generally a safe option to try first for many types of pain, including chronic pain. Ask your health care provider for guidance about other medications to avoid while taking acetaminophen. Acetaminophen is not as effective as NSAIDs for the treatment of knee and hip pain related to osteoarthritis.

COX-2 inhibitors

These medications were developed to reduce common side effects associated with traditional NSAIDs. COX-2 inhibitors commonly are used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps. They are as effective as NSAIDs and may be the right choice if you need long-term pain control without increased risk of stomach damage.

Brand names
An example of a COX-2 inhibitor is Celecoxib (Celebrex).
How they work
COX-2 inhibitors, another type of NSAID, work slightly differently from traditional NSAIDs. A COX-2 inhibitor blocks only the COX-2 enzyme — the one that's more likely to cause pain and inflammation.
Benefits and risks
COX-1 enzymes help protect the lining of your stomach. NSAIDs, which block COX-1, can cause side effects such as stomach pain and bleeding. COX-2 inhibitors, on the other hand, help keep the stomach protected by acting only on COX-2 enzymes, allowing COX-1 to function normally. Although the risk of stomach bleeding is generally lower if you take a COX-2 inhibitor instead of an NSAID, bleeding can still occur, especially at higher doses. These medications may cause side effects, such as headache and dizziness, and can lead to kidney problems, fluid retention and high blood pressure.
Bottom line
Older adults may be at higher risk of common COX-2 side effects compared with younger adults. If these medications help you manage chronic pain, take the lowest effective dose for the shortest time possible, and follow up closely with your health care provider.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

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Mayo Clinic Minute: What are NSAIDs?

Jason Howland — Wed, 16 May 2018 06:00:25 +0000

When searching for over-the-counter pain relief, you've probably taken an NSAID medication, such as ibuprofen or naproxen. But what kind of pain does an NSAID treat best and are there risks of side effects?

Jason Howland has more in this Mayo Clinic Minute.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video pkg (1:00) is in the downloads. Read the script.

Reducing inflammation, that's what over-the-counter pain relievers like ibuprofen and naproxen do — a class a medications called NSAIDs.

"That stands for nonsteroidal anti-inflammatory drugs," says Dr. Carrie Krieger, a clinical pharmacist at Mayo Clinic.

Ibuprofen, also known by brand names Advil and Motrin, and naproxen, known as Aleve, have qualities that reduce fever and help with general aches and pains. And where NSAIDs really shine is joint and muscle pain.

"It's why often those with arthritis ... that medication, because it can reduce inflammation and reduce swelling, has been most beneficial," says Dr. Summer Allen, a Mayo Clinic family physician.

Typical over-the-counter doses for ibuprofen are 200 or 400 milligrams, not more than every six hours. Overuse of NSAIDs over an extended period of time can cause side effects.

"One of our greatest concerns with NSAIDs for patients is the fact that it can lead to bleeding in their GI, or stomach lining or tract," says Dr. Allen.

"They can also cause concerns for people, particularly those who have reduced kidney function, they have been associated with kidney injury, in some cases," says Dr. Krieger.

If you have questions about NSAIDs, talk to your health care provider or pharmacist.

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Some pain medicines may increase heart attack risk after surgery

Dana Sparks — Tue, 16 May 2017 19:33:11 +0000

There's more research pointing to an increased risk of heart attack when taking over-the-counter pain medications, especially in the first week after surgery.

In a McGill University study published recently in the British Medical Journal, researchers found that post-surgery use of nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with a significant risk of acute myocardial infarction.

Mayo Clinic cardiologist Dr. Stephen Kopecky, who was not involved in the study, says, "This isn't much different than previous reports, except it shows it happens within a week, which is somewhat new information. It's clear that if you have coronary artery disease or had a prior heart attack, bypass or stent, then there's a potential price to pay for overuse of over-the-counter painkillers."

In this Mayo Clinic Q and A: Risk of heart disease associated with NSAIDs article, Mayo Clinic cardiologist Dr. Rekha Mankad says, "Examples of NSAIDs include the nonprescription medications ibuprofen (Advil and Motrin) and naproxen (Aleve). NSAIDs available by prescription include diclofenac sodium (Voltaren and Solaraze) and celecoxib (Celebrex). Although aspirin is considered a type of NSAID, it doesn’t appear to be associated with a higher risk of heart attack or stroke."

Dr. Kopecky adds,"Since these medicines are over-the-counter, many people assume they're safe and they can take them without side effects. This is clearly not true if you have heart disease. The key point here is to try to take either aspirin or Tylenol (Acetaminophen) when possible for pain or use local treatments, such as ice, heat or rest."

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Mayo Clinic Q and A: Risk of heart disease associated with NSAIDs

Liza Torborg — Tue, 02 May 2017 11:00:37 +0000

DEAR MAYO CLINIC: Is it true that taking prescription-strength nonsteroidal anti-inflammatory drugs, or NSAIDs, can increase my risk of heart disease? How much is too much, and should I be concerned about regularly taking over-the-counter NSAIDS?

ANSWER: Research has shown that taking NSAIDs can raise the risk of heart disease, particularly heart attacks and strokes. To keep your risk low, if you use NSAIDs, take the lowest dose possible for the shortest amount of time necessary to relieve your symptoms.

NSAIDs are drugs commonly used to treat pain and inflammation. Examples include the nonprescription medications ibuprofen (Advil and Motrin) and naproxen (Aleve). NSAIDs available by prescription include diclofenac sodium (Voltaren and Solaraze) and celecoxib (Celebrex). Although aspirin is considered a type of NSAID, it doesn’t appear to be associated with a higher risk of heart attack or stroke.

The risk of heart disease associated with NSAIDs is highest in people who already have a heart condition. But it can be a concern in those who don’t have heart problems, too. The reason for the connection between NSAIDs and heart disease is unclear. The risk was first uncovered in a clinical research study conducted in 2003. The study looked at NSAIDs called COX-2 inhibitors, and it found that the medications were increasing cardiovascular events. Some drugs were taken off the market as a result of that study.

The COX-2 inhibitor that’s now on the market, celecoxib, is formulated differently than those in the 2003 study. The heart disease risk associated with celecoxib is lower than the older COX-2 inhibitors, but it still exists. However, research has shown that celecoxib’s heart disease risk is no higher than that of ibuprofen or naproxen. Celecoxib is most often recommended for people with rheumatoid arthritis, osteoarthritis, menstrual cramps and injury-related pain. It’s available by prescription only.

Although there is a higher risk of heart disease associated with NSAID use, that doesn’t mean these medications are unsafe. If you don’t have a history of heart problems, it’s fine to take NSAIDs occasionally in the recommended doses for short-term pain relief.

NSAIDs become a more significant concern if you regularly use them to treat chronic conditions, such as osteoarthritis or rheumatoid arthritis, over a long period of time. If you take multiple doses of NSAIDs daily for weeks at a time to combat pain due to a chronic illness, talk to your health care provider about an alternative that may be able to keep your symptoms in check without increasing your heart disease risk.

If you have a history of heart disease or other heart problems, talk to your health care provider before you take any NSAIDs, including those you can buy without a prescription. He or she may recommend you use another type of medication, such as acetaminophen, for pain relief that isn’t associated with an increase in heart disease risk.

Whenever you visit your health care provider, make sure he or she knows about all the medications you take regularly — both prescription and nonprescription, including NSAIDs and other over-the-counter pain relievers. If you have any concerns about your medications, your provider can help you review the pros and cons, and sort out what’s right for your situation.

Finally, when you take NSAIDs, read the label instructions carefully before you take them, and use NSAIDs only as directed. Talk to your health care provider if you have questions about NSAIDs. — Dr. Rekha Mankad, Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota

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#MayoClinicRadio Podcast: 3/4/17

Jennifer O'Hara — Mon, 06 Mar 2017 17:30:50 +0000

Listen: Mayo Clinic Radio 3/4/17

Multiple sclerosis, commonly known as MS, is a potentially disabling disease of the central nervous system. March is Multiple Sclerosis Awareness Month, and, on the Mayo Clinic Radio podcast, Dr. Mark Keegan, a neurologist and MS division chair at Mayo Clinic, discusses treatment options for MS. Also on the program, cardiologist Dr. Rekha Mankad explains why caution should be used when taking nonsteroidal anti-inflammatory drugs such as ibuprofen. And Dr. William Hogan, director of the Mayo Clinic Bone Marrow Transplant Program, shares how and why a bone marrow transplant is done.

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Multiple Sclerosis Awareness Month: Mayo Clinic Radio

Joel Streed — Sun, 05 Mar 2017 23:35:46 +0000

Multiple sclerosis, commonly known as MS, is a potentially disabling disease of the central nervous system. In MS, the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body. Eventually, the disease can cause the nerves themselves to deteriorate or become permanently damaged. March is Multiple Sclerosis Awareness Month, and, on the next Mayo Clinic Radio program, Dr. Mark Keegan, a neurologist and MS division chair at Mayo Clinic, will discuss treatment options for MS. Also on the program, cardiologist Dr. Rekha Mankad explains why caution should be used when taking nonsteroidal anti-inflammatory drugs such as ibuprofen. And Dr. William Hogan, director of the Mayo Clinic Bone Marrow Transplant Program, will explain how and why a bone marrow transplant is done.

Here's the Mayo Clinic Radio podcast.

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Mayo Clinic Radio: Multiple Sclerosis Awareness Month

Jennifer O'Hara — Thu, 02 Mar 2017 12:00:37 +0000

Listen to the program on Saturday, March 4, at 9:05 a.m. CST, and follow #MayoClinicRadio.

Mayo Clinic Radio is on iHeartRadio.

Access archived shows.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

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Mayo Clinic Radio: Multiple sclerosis / nonsteroidal anti-inflammatory drugs / bone marrow transplant

Jennifer O'Hara — Mon, 27 Feb 2017 19:11:41 +0000

Listen to the program on Saturday, March 4, at 9:05 a.m. CST.

Miss the show? Here's the Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

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Colorectal cancer prevention: A proven benefit of nonsteroidal anti-inflammatory drugs

Elizabeth Zimmermann — Mon, 19 Dec 2016 20:30:41 +0000

ROCHESTER, Minn. — Mayo Clinic researchers and a team of collaborating scientists from across the country have determined the comparative effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin and several supplements in preventing the recurrence of advanced neoplasia (polyps that are the precursor of colorectal cancer) after polyp removal.

According to the World Cancer Research Fund, colorectal cancer is the third most common cancer in the world. In the U.S., more than one-third of people who develop colorectal cancer will die of the disease, with most of those cancers arising from advanced neoplasia (also known as advanced adenomas or adenomatous polyps).

In their study, published this month in The BMJ, the research team showed that, for most patients, nonaspirin NSAIDs (e.g., ibuprofen) work better than aspirin or a host of nutritional supplements to prevent the growth of advanced adenomas. In the paper, they say that due to most colorectal cancers developing from this type of polyps, preventing them is a good proxy for colorectal cancer prevention.

“Approximately 85 percent of all colorectal cancers are thought to result from untreated adenomatous polyps,” says M. Hassan Murad, M.D., a clinical epidemiologist and preventive medicine physician at Mayo Clinic, and the study’s senior author. “If we can find a way to stop their growth, we could prevent a majority of these cases.”

MEDIA CONTACT: Elizabeth Zimmermann Young, Mayo Clinic Public Affairs, 507-284-5005, newsbureau@mayo.edu

“We knew that aspirin and other NSAIDs have a protective effect, and that a number of other nutritional supplements have also been studied for their effectiveness in preventing cancer,” says Dr. Murad. “What we didn’t know is how they compared to each other.”

The team conducted a meta-analysis (a statistical research method that involves combining data from multiple studies to obtain a single consolidated observation) of clinical trial data from 15 randomized control trials, reviewing information from 12,234 patients. These studies included low- and high-dose aspirin therapy, calcium, vitamin D and folic acid, and compared them each alone or in various combinations.

Dr. Murad and his colleagues showed that nonaspirin NSAIDs are better than all the other compared therapies for preventing recurrence of adenomatous polyps within three to five years following initial polyp removal. However, because of some of the other health risks of nonaspirin NSAIDs, they may not be the best choice for everyone.

Aspirin had nearly as good results, with much less additional risk. Dr. Murad and his colleagues cautioned that, although low-dose aspirin was ranked second in preventive capabilities, “the excess benefit over risk might therefore be favorable for many patients.”

“It is important that patients and doctors have a discussion on the various risks and benefits of any medication or other therapy,” says Dr. Murad. “While a research publication may contain promising findings, it is generalized information, and each individual is different. So their care will be individualized, as well.”

Dr. Murad is part of the Mayo Clinic Robert D. and Patricia E. Kern Center, where he leads the Knowledge Synthesis Program. In addition, he heads Mayo Clinic’s Evidence-based Practice Center. His group conducts systematic reviews, such as this study, where they collect, appraise and summarize the available evidence on a topic. These evidence summaries help patients, physicians, guideline developers, and other stakeholders make decisions consistent with the best available evidence.

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