The Whitworths of Arizona, bringing science to you in everyday language.

Friday, October 16, 2015

NSAID Pain Relievers and LBD

Last week we discussed pain drugs in general. This week, the blog is about NSAIDs (non-steroidal anti-inflammatory drugs) specifically. These are the most used of all drugs for pain, both short term and long term. Most of us have used them at some time or another. Many of us use them regularly for chronic pain. Some of us, myself included, used to use them but were told by our doctor that we couldn't anymore because they'd begun to irritate our stomachs. But how are they with our LBD loved ones?

First, a quick NSAID overview: These drugs include over-the-counter (OTC) drugs such as aspirin, ibuprofen (Advil), naproxen (Aleeve) as well as some newer prescription drugs. NSAIDs come in "selective" and "non-selective" forms. Most OTC drugs are non-selective, i.e., they block both pain-signaling enzymes and enzymes that protect the lining of the stomach.

Newer "selective" prescription drugs, such as celecoxib (Celebrex) and meloxicam (Mobic), are designed to select and block only the pain-signaling enzymes. These newer drugs do appear to have fewer side effects related to the stomach and bowels than other NSAIDs. However, it turns out that the pain-signaling enzymes also affect kidney function and blood pressure. Eventually, the risk of heart failure becomes "similar to that of being a smoker or a diabetic." This is true for all types of NSAIDs, selective or non-selective, OCT or prescription.

Aspirin is also an NSAID but it is little different, in that it also acts to thin the blood. Doctors often prescribe it in mini-doses for this purpose. Taken in such small amounts, it usually doesn't have the same negative effects as other NSAIDs, even when taken over long periods of time. Taken in doses large enough to affect pain, it may have the same negative effects as other NSAIDs.

People have used these drugs for decades for occasional pain, with few reported side effects. The most common side effects involve gastrointestinal distress, such as stomach upset, cramping, diarrhea, ulcers and even bleeding. NSAIDs are also believed to increase the risk of serious cardiovascular conditions (such as heart attack or stroke), especially for those patients already at risk for these conditions...which includes most PwLBD.

Last week's blog noted the three ways that the elderly, and PwLBD especially, process drugs differently from our younger relatives. LBD's drug sensitivity is less of an issue with NSAIDs but other issues are serious: the age-related decrease in the body's ability to process drugs and the likelihood of accompanying issues such as diabetes or high blood pressure. The elderly are also more apt to have chronic pain, often from arthritis, and to use NSAIDs for this. Taking these drugs long term greatly increases the risk of side effects.

Not only are the additional illnesses themselves a concern. So are the drugs a person might be taking for those other illnesses because of how the NSAIDs may interact with them. For example, they significantly increase the danger of internal bleeding when taken with blood thinners. Many NSAIDs are available without a prescription but even so, no elderly person should use them without checking with the doctor or pharmacist first. Naturally, this is even more important for long term use, as with arthritis.

Most PwLBD already have GI issues and many already have heart or blood pressure issues. Many already take baby aspirin to thin their blood. Therefore, it is our opinion that NSAIDs are seldom a good option for long term use by your LBD loved ones. These are the adverse symptoms you should look for when using these drugs:

• GI tract: bleeding ulcers, heartburn, constipation, abdominal pain, nausea, diarrhea and vomiting.

• Heart: Raised blood pressure, fluid retention, congestive heart failure

• Central nervous system: Headaches, dizziness and drowsiness. Ringing in the ears.

• Skin: Sensitivity to sun, rash, easy bruising

• Kidneys: Restricted blood flow, poor kidney function

• Can increase potassium levels which can interfere with other drug function.

You should avoid NSAIDs if you have dehydration, cirrhosis, renal disease, or if you are taking an anticoagulant drug (blood thinner) even if it is just baby aspirin. Renal function and potassium levels should be checked regularly.

Most experts advise the elderly to avoid using these drugs long term. If you use NSAIDs at all, use them just to take the edge off the pain. Then consider using a non-drug therapy such as deep breathing, essential oils, massage or aromatherapy.

The next blog in this series will be about opiate and narcotic pain-killers.

For more about NSAIDs, read the following articles:

FitzGerald G. (2012) NSAIDs and Cardiovascular Risk Explained, According to Studies from the Perelman School of Medicine.

Smith S G. (1989) Dangers of NSAIDS in the Elderly. Can Fam Physician. 1989 Mar; 35: 653–654.

Peterson K, et al. (2010) Drug Class Review: Non-steroidal Anti-inflammatory Drugs (NSAIDs). Oregon Health & Science Univerisity, 2010 Nov.

Cryer B, et. al. (2005) Pain Relief: How NSAIDs Work. WebMD, Arthritis Health Center.

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia

Managing Cognitive Issues in Parkinson’s & Lewy BodyDementia

Helen and James Whitworth are not doctors. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a physician's advice.

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