NSAID pain relievers, including common over the counter medications, linked to a 50% increase in heart attacks. 
Most people aren’t not be aware of the potential risks because we often incorrectly assume that if you can buy something over the counter than it must be very safe.
This is unfortunately not true as we’ll talk about below.
What are NSAIDs?
Nonsteroidal anti-inflammatories (NSAIDs) are a group of medicines that are meant to relieve pain, reduce fever, and reduce inflammation.
They work by blocking an enzyme in the body that produce something called prostaglandins.
These prostaglandins activate platelets and protect the lining of the gut.
The COX enzymes also release prostaglandins after infection or injury to help your body respond to the problem and heal.
One of the ways our body heals is through inflammation.
Which pain relievers are NSAIDs?
- Aspirin
- Ibuprofen (Advil, Motrin)
- Naproxen (Aleve, Anaprox DS, Naprosyn)
- Celebrex, Consensi (similar to the other Cox 2 inhibitors Vioxx and Bextra)
- Ketorolac (typically injected)
- Diclofenac (topical)
We’ve known for some time that NSAIDs increase the risk of heart attack.
- Researchers found the heart attack risk was greatest during the first month of use.
- Higher amounts were associated with greater risk.
- After a month, the risks did not appear to increase over shorter term use.
- Daily use of 200mg of celebrex, 100mg of diclofenac, 1200mg of ibuprofen, or 750mg of naproxen for just 8 days increased the risk of a heart attack.
- NOTE: The recommended safe dose of ibuprofen is 1200mg for menstrual cycle related pain, the same dose seen to raise heart attack risk…
- And the use of up to 3200mg for arthritis or a fever which is much higher than the dose associated with heart attacks.
Is a daily aspirin safe?
Many doctors recommend taking an aspirin to stop an impending heart attack.
The daily use of aspirin heart benefits should be weighed against risks and health concerns.
An interesting recent study called into question the use of low dose aspirin in this case in older adults.
A 2018 study found, “Conclusion: The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.”
NSAID risks are not limited to heart attacks.
NSAIDs such as aspirin, ibuprofen, and naproxen are the most commonly used pain relievers for painful conditions like headaches, neck pain, shoulder pain, back pain, knee pain, arthritis, bursitis, and tendinitis.
These pain relievers also reduce inflammation, reduce fever, and help prevent blood clotting.
NSAIDs work by blocking the COX enzyme in our bodies.
The COX enzyme has different forms which do different things in our bodies…
- COX 1 protects the lining of the stomach from and helps the maintain kidney function.
- COX 2 is involved in the synthesis of prostaglandins that cause pain and inflammation in the body, as mentioned above.
NSAIDs block the actions of both these COX enzymes, which is why they can cause stomach problems.
COX-2 inhibitors are meant to target the COX 2 enzyme in order to reduce the inflammatory response.
Unfortunately for many people, COX 2 can still have serious side effects including stomach pain, nausea, indigestion, and even abdominal bleeding.
Anyone with a history of heart or cardiovascular problems including… angina, heart attack, stroke, blood clots, or hypertension should definitely talk to your doctor about potentially serious problems.
NSAIDs block the stomach protection of the COX 1 enzyme.
This means that they can cause stomach upset and bleeding, among other fairly common side effects…
- Heartburn
- Gas
- Bloating
- Vomiting
- Nausea
- Diarrhea
- Constipation
- Mild headache
- Dizziness
- Difficulty concentrating
If you already have stomach problems or other health problems including diabetes, liver disease, kidney disease, asthma, a history of stroke, heart attack, IBS, Crohn’s disease, or pregnancy then you should definitely speak with your health care practitioner before taking NSAIDs – even over the counter ones listed above.
NSAIDs linked to leaky gut (intestinal permeability)
Another reason to avoid NSAIDs is that they have the potential to cause or worsen leaky gut.
Inflammation and damage to the lining of the gut causes it to open up and become more permeable or ‘leaky.’
This allows larger food particles and other problematic things like bacteria and toxins to get through the intestinal wall and into the bloodstream.
This further causes an immune response including driving inflammation and pain throughout the body.
The same type of process also occurs at the blood brain barrier and can lead to very serious neurological problems and neurological autoimmunity.
Pain Relievers
The reality is that it might be necessary in certain people to use medications.
Ideally it would be for as short a term as possible… but as we’ve seen above even short term NSAID use increases risks of very serious side effects including heart attacks.
Many people with heart problems, other cardiovascular problems, stomach problems, etc may not be able to take these medications because there may be greater risk for them.
Opiates also carry serious risks, including addiction and unfortunately death.
Adding to the problem with these medications is that they do not ever address any abnormal movement patterns that will generally require physical treatment to improve and prevent further problems from occurring.
Medication does not address movement. This is what we do as chiropractors.
NSAID Pain Relieving Alternatives.
Chiropractic Care offers a safe, effective alternative for so many people with pain.
In fact, Chiropractic Care often works better than pain relievers.
Some lifestyle changes and even supplements can make a huge difference in your pain levels.
Many times, attacking the problem from multiple angles can lead to remarkable improvement in even very severe pain.
The best part is that you improve your pain while improving your health and not losing it.
The reason that many people continue suffering with chronic pain is because they aren’t getting the right kind of treatment to help them.
Most people don’t know to see a chiropractor and their MD is unlikely to tell them that it’s an option that may take care of their problem.
Do you need to see Dr. Hagebusch at our Texarkana Chiropractic Clinic?
We’re here to help you like we’ve helped thousand’s of other Texarkana residents since 1999.
References
1. https://www.webmd.com/arthritis/features/pain-relief-how-nsaids-work
2. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. October 18, 2018. N Engl J Med 2018; 379:1509-1518. https://www.nejm.org/doi/10.1056/NEJMoa1805819
3. https://www.health.harvard.edu/heart-health/does-aspirin-stop-a-heart-attack
4. https://www.health.harvard.edu/blog/fda-strengthens-warning-that-nsaids-increase-heart-attack-and-stroke-risk-201507138138
5. https://www.mayoclinic.org/diseases-conditions/heart-attack/expert-answers/nsaids-heart-attack-stroke/faq-20147557
6. Heightened risk of heart attacks found with common painkillers in routine use. https://www.bmj.com/company/newsroom/heightened-risk-of-heart-attacks-found-with-common-painkillers-in-routine-use/
7. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1909
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