Chiropractic 5x better than NSAIDS Relievers

Ibuprofen WARNING: Regular usage for just ONE week 'increases heart attack risk'

EXPERTS have advised people to try and avoid regularly taking ibuprofen after research showed just a week on the painkiller was enough to increase the risk of a heart attack by half.

A major new analysis has unmasked the health hazard in the common anti-inflammatory drugs with evidence suggesting the danger exists even after one day.

The scientists say the over the counter and prescription pills including ibuprofen, diclofenac, celecoxib and naproxen should now be used with care and at the lowest possible dose.

Heart attack risk increases with age and is made worse by raised cholesterol. So the experts say older people especially now need to carefully weigh up the need to take anti-inflammatories with their GP.

The latest strong note of caution over the group of medicines known as non-steroidal anti-inflammatory drugs [NSAIDs] has been urged following analysis of the health records of almost 500,000 people.

Sotiris Antoniou, of the Royal Pharmaceutical Society, said: “We now know all NSAIDs have the potential to increase the risk of having a heart attack. This paper suggests the larger the dose and the longer duration is associated with greater risk of harm.

“If you have any doubts or questions seek advice from a pharmacist or doctor. It’s a good rule of thumb with any painkiller to take the lowest dose that’s effective for the shortest possible time.”

NSAIDs are a group of drugs taken by patients suffering joint problems, backache and arthritis.

People must be made aware of the risk

Dr Mike Knapton

They are frequently prescribed to relieve pain, reduce inflammation and quell fever.

Although they are used by millions each day the NHS said the drugs were not suitable for everyone and could “sometimes cause side-effects”.

The latest research, published in the British Medical Journal, suggests it is wrong for people to assume the over-the-counter and frequently prescribed painkillers are harmless and safe.

Scientists from the University of Montreal Hospital Research Centre based their findings on drug prescribing or dispensing data from 446,763 people in Britain, Canada and Finland 61,460 of whom had a heart attack.

The observational study found taking any dose for one week, one month or more than a month was associated with an increased risk.

Previous studies pointed to an increased risk of heart attack with particular NSAIDs, like rofecoxib, but the latest research suggests for all common NSAIDs the risk of heart attack starts as early as the first one to seven days of use.

The study also showed that use of NSAIDs in the first month at a high daily dose [celecoxib 200 mg], diclofenac [100 mg], ibuprofen [1,200 mg] and naproxen [750 mg] was associated with the greatest risk.

Overall, researchers found risk of a heart attack is increased by about 20 to 50 per cent with the use of commonly available NSAIDs. However, on average, the risk of a heart attack due to NSAIDs is only about 1 per cent per year.

Epidemiologist Michele Bally, who led the study, said: “Given the onset of risk occurred in the first week and appeared greatest in the first month of treatment with higher doses, prescribers should consider weighing the risks and benefits of NSAIDs before instituting treatment, particularly for higher doses. We studied more than 60,000 cases and our results were precise enough to conclude that the use of all common NSAIDs is associated with a heightened risk of heart attack.”

NHS guidance recommends adults and children over 12 can take 300-400mg of ibuprofen 3-4 times a day, increased to a maximum 2.4g daily if necessary. Packs of the drug are widely available in supermarkets for as little as 50p.Dr Ian Campbell, a family GP from Nottingham for more than 30 years, said: “This is really concerning. We have until now been attributing most heart attack risk to NSAIDs like diclofenac but this study suggests the risk of taking more commonly prescribed drugs such as naproxen are equally large. Additionally, the risk appears to be fairly immediate, even within one week, so previous advice to use the smallest dose for the shortest period appears to be of reduced significance. We now need to evaluate every prescription for NSAIDs in those at risk. Older people with additional risk factors need to weigh up the need for anti-inflammatory medicines very carefully, every time.”

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “NSAIDs can be effective in providing short term pain relief for some patients – what is important is any decision to prescribe is based on a patient’s individual circumstances and medical history and is regularly reviewed.”Experts were not able to say what the potential underlying cause for increased heart attack is but previous research has suggested it might involve drugs blocking prostacyclin, a hormone that protects blood vessels and the kidney and thins the blood.

Dr Mike Knapton, associate medical director at the British Heart Foundation, said: “We already know these drugs increase your risk of having a heart attack. However, this large-scale study worryingly highlights just how quickly you become at risk of having a heart attack after starting NSAIDS. Whether you are being prescribed painkillers like ibuprofen, or buying them over the counter, people must be made aware of the risk and alternative medication should be considered where appropriate.”

Kevin McConway, emeritus professor of applied statistics at The Open University said: “This new study has helped persuade me that there is probably a real association between taking these painkillers and heart attacks

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This white paper discusses the significance of the study published in the July 15, 2003 journal of Spine titled “Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture, and Spinal Manipulation.”

 This study proved Chiropractic to be five times better at alleviating pain than NSAID drugs and three times better than Acupuncture. The results of the study stand alone in proving the superiority of Chiropractic and pain, but the findings in the research showed more. There was a clear connection between those receiving chiropractic care and improved overall health status beyond pain relief compared to those receiving acupuncture and NSAIDs. The highlights of the study are as follows:

• The study was designed to assess the long-term benefits of medication, needle acupuncture, and spinal manipulation as exclusive and standardize treatment regimens in patients with chronic (greater than 13 weeks) spinal pain syndromes.

•  115 patients were originally randomized, 69 had exclusively been treated with the randomly allocated treatment during the nine week treatment period. 

• The patients were followed up and assessed again one year after inception into the study reapplying the same instruments: Oswestry back pain index, neck disability index, short form-36, and visual analog scales. 

• Within nine weeks of treatment, 27.3% of the patients getting Chiropractic adjustments reported being asymptomatic compared with only 9.4% of the Acupuncture group and 5% of the group getting NSAIDs.

• Patients assigned to the group receiving Chiropractic care had experienced chronic pain for almost twice the amount of time as the subjects in the other two groups: the group receiving Chiropractic reported having chronic pain for 8.3 years, compared to only 4.5 years for the subjects receiving medication and 6.4 years for the patients receiving Acupuncture.

•  None of the subjects receiving Chiropractic or Acupuncture reported suffering from any adverse events from the treatment, however, 6.1% of the subjects treated with NSAIDs reported suffering an adverse event. 

•  One of the most interesting statistics of the study recorded the percentages of people who reported an improvement of overall general health status beyond just pain relief. The percentage of patients experiencing better overall health were as follows: o 18% for the subjects treated with NSAIDs, 15% for the subjects treated with Acupuncture, and 47% for the subjects receiving Chiropractic adjustments. 

In a world that is taught to quickly turn to medications for pain relief, it is important to note that more patients in this study (6.1%) experienced adverse events from the drugs than recovered from their spinal complaints (5%). Chiropractic has always advocated more benefits than simple pain relief, and studies like this help to put the nails in that coffin of truth. Chiropractors strive to educate the public on its benefits beyond just pain relief. This study, which largely focused on the effects of treatment on chronic spinal pain, also helped to prove that improveme