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BY DR. DWIGHT TYNDALL
Times Correspondent | Tuesday, May 02, 2006 | (No comments posted.)
Q: Why are anti-inflammatories used for musculoskeletal pain, including back pain etc? Why don't more doctors prescribe medications such as Vicodin? -- Paul L.
A: The anti-inflammatory medications that you refer to are part of a class of drugs called Non-Steroidal Anti-Inflammatory Drugs; NSAID for short. They are called NSAID since they have anti-inflammatory properties but are not steroids, which have very powerful anti-inflammatory actions.
These medications are used extensively for musculoskeletal pain since it is thought this pain is caused by inflammation either from trauma (accidents, fall etc) or from the aging/degenerative process. These medicines work by blocking a inflammatory agent called prostaglandin, which are responsible for the inflammatory reaction and pain/swelling. For most of these drugs to work consistently they need to taken on a regular basis or until the inflammatory process is over.
A very common side effect of these medications is that they not only block the "bad" prostaglandins but also the "good" ones, which are responsible for protecting the stomach. It is for this reason that these medicines can cause stomach ulcers, which are a very serious side effect of taking these drugs. Another serious side effect is damage to the kidneys, which can occur with long-term use of these medications.
Two of the newer NSAID, Vioxx and Bextra, which were meant to be safer on the stomach, were removed from the market due to possible increased risk of heart attacks in patients taking these drugs.
The reason why more doctors don't prescribe Vicodin and other narcotics for pain can be attributed to their addictive and abuse potential. Also, these medications can be less effective for long-term pain relief since the body accommodates to them, needing more and more to have the same effect.
The opinions expressed solely are those of the writer. Dr. Dwight Tyndall is a practicing Spine Surgeon. He can be reached at dstyndall@yahoo.com (use the subject line "bone doctor column") or at Dr. Dwight Tyndall, 730 45th St., Munster, IN 46321. This column is intended for informational purposes only. Reader should seek specific medical advice from their own physician.
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