Manor Field Surgery Blog No. 9 – What about anti-inflammatories?

Yesterday, (Blog No. 8) I wrote about pain.

I suspect some people will be wondering why I didn’t mention either anti-inflammatories or indeed, the other large group of painkillers related to morphine.

Well, I thought it was just a little too much to squeeze-in to 500-odd words and you could say that this introduction is already too long, so I had better get on with it!

Anti-inflammatories (known as NSAID’s – non-steroidal anti-inflammatory drugs) are an incredible group of medicines that are probably amongst the best form of pain-relief (they have other properties too) yet discovered. This isn’t an exaggeration – I believe it to be true, yet, as with virtually every medicine, they come with cautions and side effects and that is their limitation.

I will give a quick overview here.

What are some anti-inflammatories?

Ibuprofen, Diclofenac, Naproxen and Indomethacin are amongst the most common.

What pain do they relieve?

Well, virtually everything – obviously inflammation, which is associated with a sprain or injury, but, also inflammation from an infection or other wound, they work for headaches, painful shoulders, backs and knees, kidney stones, arthritis and gout.

The list is long.

This is surely fantastic – so, what is the problem?

Well, part of how they work affects certain enzymes and chemicals in the body that stop  or reduce inflammation (duh!), and, somewhat unsurprisingly, inflammation although a problem at times, for example, a sore knee, is also part of our general human adaptation to life, in other words, it is how we have evolved.

(What I mean by this, is, our bodies are so sophisticated that we have not begun to understand them and much of what happens inside us is actually good, even pain, like I mentioned in the previous blog; it just might not feel like it at times).

The downsides?

The list is probably as long as the conditions treated – here are the most common.

Whenever someone mentions these medicines to me, the first two side effects that come to mind are –

1. Effects on the stomach – they are associated with ulcers, indigestion and heart-burn; this is why, if you are taking them for a prolonged period of time (probably on a doctor or other clinician’s advice) you should also take another class of medicine called ‘proton-pump inhibitors’ (e.g. Lansoprazole, Omeprazole) as these can help reduce the damaging effects on the stomach; they also themselves have side-effects that I won’t go into here, but you can see the potential complications start to increase.
2. Effects on the kidneys – these medicines have another strange side-effect in that they can reduce the flow of blood to the kidneys; if your kidneys are healthy, you aren’t taking any other kidney-affecting medicines (such as certain blood-pressure treatments, for example) and you are reasonably well hydrated (Blog 6), you should be OK. It is just that often, and particularly with some of the older people I see, this is not the case and kidney damage can follow.

These are the main reason I didn’t include say, Ibuprofen in my pain blog; you can’t really recommend it without these caveats.

And, yes, there are other complications – associations with heart attack and stroke, worsening of asthma and so on (all these are relative and their understanding part of the job that is being a doctor/pharmacist/prescriber).

I don’t want to freak anyone out and, if you have been taking these for a while they are almost certainly fine for you.

The question as to why I haven’t mentioned aspirin here might also come to certain people, for it is very similar to the above; it is just quite special, in a class of its own and probably deserves its own blog.

For now, stay safe – read the instructions that come with any medicines (inside the box/carton) (or ask your chemist) and as I have already mentioned, pain is sometimes a blessing, it tells us that something is wrong; equally most pain is transient, it passes in a few days and we forget about it in time.

Be well.