Recent studies acknowledge the risks posed with popping of painkillers in an unregulated fashion. While the more common side effects related to gastrointestinal problems have been well established, the potential harm contributing to heart failure incidences is of concern.

This is an area of interest especially in our local community where taking some paracetemol or ibuprofen for any pain regardless of site or intensity has become second nature to many Malaysian patients whenever a mild fever or headache strikes.

Not all painkillers are composed to act in the same way

According to a recent report, painkillers with anti-inflammatory properties in particular ibuprofen and naproxen at prescription-strength may be particularly detrimental. The scenario becomes more worrying as diclofenac is one of the most commonly used pain killer in Malaysia according to the Malaysian Pharmaceutical Society (MPS).

The study found that people who had consumed any NSAID in the last 14 days had a 19% increased risk of heart failure compared with the control arm of a history of NSAID use at any given point in time. Related drugs known as COX-2 inhibitors were also implicated.The BMJ research was led by a team from the University of Milano-Bicocca in Italy.

The link to heart failure from usage of painkillers had been demonstrated by previous studies whereby non-steroidal anti-inflammatory drugs, commonly known as NSAIDs, caused patients to be hospitalised for this particular heart condition.

The other group of which one may resort to for better effect are opioids, which are drugs commonly given to treat cancer, but can also be prescribed for common, painful ailments such as those of the muscles and joints. But Dr Ho Kok Yuen, president of the Pain Association of Singapore, said many doctors prefer to steer clear of prescribing such medication due to the risk of patients getting hooked.

Perfect recipe for disaster

There is a long list of pain killers made easily available over-the-counter that many of us give not a second thought in taking. This practice is especially common in the elderly who depend on pain medications to counter pain caused by wear and tear of joints which is a chronic condition. It is hence by default that people with long-term conditions such as arthritis will rely on NSAIDs for a prolonged period.

It is also in this group where a lack of awareness and knowledge on the dangers of unregulated usage is rampant. Unfortunately, these older folks are the most likely to be affected because they are the most prone to suffer from various heart diseases.

Habitual pill-popping amidst over-prescription by doctors

NSAIDs are so widely used due to the fact that they perform dual roles. "They not only relieve pain, but they reduce inflammation too," says Dr. Lucy Chen, an assistant professor at Harvard Medical School.

Almost any condition contributing to inflammation and pain from head throbbing to ankle swelling is conveniently treatable by NSAIDs. It is also relatively inexpensive and has less of an addiction stigma unlike the opioids which are a category above in pain management. As its mechanism of action is fast acting and has a short half life, it also does not remain in the body for long which is good for short term use.

“Although over-the-counter NSAIDs are typically used at lower doses and for shorter durations, they are sometimes available at the same doses as prescription NSAIDs and they may be inappropriately overused,” warned study author Andrea Arfe from the University of Milano-Bicocca.

This recent study serves as a reminder to doctors to place more thought and consideration in prescribing NSAIDs and also to patients not to be cautious in self administration. More research is needed to determine the absolute risks, longer term consequences and effects in refined subgroups, as well as whether lower doses of these drugs are equally dangerous. MIMS

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