Non-Steroidal Anti-Inflammatory drugs (NSAIDs) for Neck Pain
Non-Steroidal Anti-Inflammatory drugs (NSAIDs) have been used for many years as a method for treating both acute and chronic neck pain. In the US it is estimated that an average 60 million people regularly use NSAIDs such as aspirin, ibuprofen, diclofenac, arthrotec, celecoxib, and naproxen (Dai, 2005). In 1971 scientists in Sweden discovered that aspirin-like drugs effectively inhibited prostaglandin synthesis, and connected the production of prostaglandins to trauma, disease, and stress (Vane, et al, 1971). They theorised that the reason NSAIDs reduced inflammation and pain (which remained largely unclear up until this point) was due to the drugs’ inhibition of the synthesis of prostaglandins, and associated thromboxanes, which are made in the body from unsaturated fatty acids (primarily arachidonic acid). The knowledge of their mechanism of action is fairly new, and with that increased knowledge has come a fuller understanding of the potential side-effects and dangers of NSAIDs.
New Types of NSAIDs
Newer types of NSAIDs, such as rofecoxib (sold as Vioxx and recalled in 2004 by manufacturer Merck), have a more specific action (inhibiting Cyclo-oxygenase-2 only), whereas traditional NSAIDs are non-selective inhibitors of the whole prostaglandin pathway (involving both COX-2 and 5-Lipo-oxygenase). What does this mean for those using these drugs? Well, the newer drugs may have less side-effects than the traditional NSAIDs making them a better option for many patients with chronic neck pain, but, as the Vioxx recall demonstrated, longer-term issues with these drugs may still be largely unknown. Scientists are also establishing a clearer connection between dietary factors, such as high consumption of animal products, and high levels of pro-inflammatory substances in the body, such as the prostaglandin-precursor arachidonic acid.
Managing Pain with NSAIDs
Many people who suffer from neck pain have considerable inflammation of the tissues and ligaments surrounding the joints in the cervical spine. NSAIDs often help alleviate this inflammation and reduce the pain, although the relief is frequently temporary as the drugs filter through the system. As a pain management technique NSAIDs can be highly effective, both alone, and in tandem with other therapeutic interventions. If used inappropriately, however, they run the risk of masking the pain, leading to potentially exacerbating activities, and can have long-term deleterious effects. Patients should consider the evidence surrounding NSAIDs before continuing to use them as there may be alternatives that can help them manage their condition (such as Fish Oil).
Some side-effects of NSAIDs mentioned in the scientific literature include cardiovascular incidents, kidney problems, and gastrointestinal damage (Cochrane, 2006). Research into the use of NSAIDs in chronic pain management has created a new approach to treatment, with protein-pump inhibitors (PPIs) now prescribed alongside NSAIDs to help reduce the incidence of gastrointestinal (GI) tract complications. PPIs’ own list of side-effects now also require careful consideration by the patient. Some of the purported benefits of NSAIDs, such as an associated reduction in risk of Alzheimer’s Disease, have also now been brought into question. Understanding the benefits and risks of NSAIDs before including them in the treatment plan for neck pain cannot be stressed enough. Each patient is different and will weigh their options on an individual basis, making adjunct therapies an important component of NSAID use for neck pain.
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Last Updated: 11/20/2010