After Vioxx: The Pros and Cons of Other Anti-Inflammatory Drugs

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All pain relievers have risks as well as benefits. Get the pros and cons of anti-inflammatory medicines here.

By Martin Downs
WebMD Feature

Reviewed By Charlotte Grayson

The recent recall of the pain reliever Vioxx has raised many questions, not the least of which is, what can patients take now?

"It's been an enormous challenge to all of us," says Terence Starz, MD, a clinical professor of medicine and chief of rheumatology at the University of Pittsburgh Medical Center. "Our practice was overwhelmed," he says.

Vioxx maker Merck & Co. voluntarily pulled the drug off the market on Sept. 30, 2004, after a study showed it doubles a person's risk of heart attack and stroke. Nearly 2 million people worldwide were taking Vioxx. Starz says almost 250 of his own patients were on it.

According to Time magazine, in the day following the recall announcement, an estimated 28,800 Americans switched to another drug. Most of them went on Celebrex or Bextra, similar drugs that had been Vioxx's competitors.

Before consumers rush to another medicine, however, experts say they should pause to weigh the pros and cons of each option. All pain relievers, even over-the-counter aspirin, Motrin, or Tylenol, have risks. It's never a good idea to take any pill every day unless you're under your doctor's supervision. Moreover, pain relievers aren't always the best treatment for many causes of chronic pain.

"Getting an accurate diagnosis and reversing known reversible causes is the first part of the treatment," says Jason Theodosakis, MD, an assistant clinical professor at the University of Arizona College of Medicine, and author of the 1996 bestseller The Arthritis Cure, now in a revised edition. "Too often a person will have joint pain, and just assume it's arthritis, or they may have five minutes with their doctor, who says, 'You have a touch of arthritis here. Take a pain reliever.'"

In fact, Theodosakis says lifestyle changes such as weight loss and low-impact exercise are essential to relieve the pain often caused by arthritis. Even treating depression seems to help relieve pain. Pain relievers should be your last resort, he says. "The goal in treatment is really to use those drugs later down the road when everything else fails."

With that caveat, what are your options now if you do need pain relief medicine? Here, briefly, are the pros and cons of each type of common pain relief medicine.

Next: The Pros and Cons of Other Anti-Inflammatory Drugs

The Pros and Cons of Older Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are some of the most common medicines taken for general aches and pains, as well as for arthritis. There are more than a dozen NSAIDs that you can take for just about every cause of pain, from arthritis to headaches to pulled muscles. The NSAIDs you're probably most familiar with are those available without a prescription. They include aspirin, ibuprofen (Advil, Motrin, Nuprin), ketoprofen (Orudis KT), and naproxen (Aleve).

Pros:

• The over-the-counter versions of these pills are inexpensive, costing only pennies per pill.
• Studies show that low doses of aspirin taken over the long term can also help prevent heart attacks and strokes.
• These drugs have been around for a long time, so much is known about them. Ibuprofen was approved as a prescription drug in 1974, and made available over the counter 10 years later. Aspirin has been on the market for well over 100 years.

Cons:

• NSAIDs tend to cause digestive problems. As many as one-quarter of those who take them regularly will experience some kind of gastric side effect such as nausea, and many people develop stomach ulcers. Depending on how many risk factors a person has, the chance of getting an ulcer from taking NSAIDs can be as high as 18% or as low as less than 1%.
• Overusing NSAIDs can cause kidney damage, too. Some people may even develop kidney problems from NSAID use even if they don't take too much.
• Because NSAIDs act as blood thinners, they're also off limits to people taking prescription blood-thinning drugs, such as warfarin (Coumadin), and people with anemia or blood clotting disorders.