NSAIDS - Dangers and how to get off them

NSAIDS - Dangers And Strategy To Get Off Them

NSAID's are over the counter pain killers.

These are very commonly used by RA sufferers to get some pain relief. However, they have a downside that directly works against the healing process.

1) They create gastrointestinal complications

This study concluded "use of oral steroids and NSAIDs was associated with about twofold and fourfold increased risk of upper gastrointestinal complications, respectively. Patients using steroids concomitantly with high-dose NSAIDs had the highest risk of upper gastrointestinal complications. Whenever possible, antiinflammatory drugs should be given in monotherapy and at the lowest effective dose in order to reduce the risk of upper gastrointestinal complications.

This study concluded "Steroids Patients taking NSAIDs who also are taking a prescription corticosteroid, medications like prednisone (in doses over 10 mg), have been found to have a seven-fold increased risk of having GI bleeding"


2) They create more 'leaky gut' and intestinal permeability

This study tested intestinal permeability in controls and in patients with active rheumatoid arthritis and found "Intestinal permeability in the patients was found to be significantly increased in comparison to controls. Of the patients, 6/7 (86%) not taking any prescribed nonsteroidal anti-inflammatory drug (NSAID) at the time of study had normal results, whereas 23/29 patients (79%) taking prescribed NSAIDs displayed increased intestinal permeability.

Possible Solutions:

a) Doctor's approach
Some GP's who have some general awareness of gut problems with NSAID's - plus, those that are extremely well educated in the intricate matters of the gut like Dr Klaper - recommend paracetamol instead of NSAID's.

In our Support Forum, @MicheleC has provided some good references for understanding the differences between NSAID's and paracetamol:
http://blog.metaome.com/use-case-2/different-strokes-common-painkillers-and-their-mechanisms/

This is a nice explanation on prostaglandins, COX 1&2 and natural COX2 inhibitors. http://www.lifeextension.com/magazine/2003/10/report_arthritis/page-01

Note that paracetamol is not really regarded as an 'anti inflammatory' and accordingly the pain relief tends to be much less than NSAID's. Watch for high doses of paracetamol. But no drug is safe. High dose of paracetamol (more than 4 day per week for more than, or equal to, 4 years) increases risk of cancer twofold.http://ascopubs.org/doi/abs/10.1200/JCO.2011.34.6346 Bottom line, in my view, is we need to do everything in our power to keep our required drug dependance to a minimum.

Note also that Celebrex and Vioxx are meant to be better for the stomach than 'normal' NSAID's. COX-2 inhibition may help perpetuate the underlying degenerative process while relieving its superficial symptoms. One researcher said “the short-term effects of (COX-2 inhibitors) on the pain and swelling of inflammation and arthritis may be achieved at the cost of an increased propensity to long-term tissue damage with which these cytokines have been associated.” 

b) Curcumin
This has a mild effect on pain reduction for some people. Didn't do a lot (if anything) for me. However, some clients have reported excellent pain relief from this by-product of tumeric. I see curcumin as a way of trying to transition away from NSAID's, or at least a way of reducing the dose.

c) Exercise more
By far my preferred way of reducing daily pain is to exercise. Cardiovascular exercise for more than 30min per day will lower pain levels. The ideal level of exercise is one in which you break a light sweat for the duration of the exercise period. Bikram yoga is ideal. Stationary bike excellent. Swimming, rowing machine, or any other exercise that is low impact and raises your heart rate is going to be a good way to go. In addition to offering the pain relief aspect, exercise has the advantage over pills (of natural or artificial nature) because it gets the joints moving. This is good practice for preserving joints long term.

Conclusion
In my view, NSAIDS should not be part of a long term healing strategy. They may hold healing back by increasing intestinal permeability. On the odd occasion like 'a bad day' then negative effects should be vastly reduced, compared to using them long term and in higher doses. The path to reduce their need is the Paddison Program and exericise for pain reduction - Bikram is best, followed by other substantial exercise alternatives. Supplements, such as curcumin, may offer a small amount of relief but the answer will come mostly from PP + substantial exercise.

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