As medicine enters a new era of pain treatment, a researcher reminded thousands of doctors yesterday that popular painkillers are not without their risks.
Even a modern generation of drugs known as COX-2 inhibitors are anything but harmless, said Henry J. McQuay, a professor of pain relief at the University of Oxford, in a speech before the 10th World Congress on Pain in San Diego.
“It’s incredible how casual and careless the doctors are, all of us,” when it comes to prescribing proper doses of mediations known as non-steroidal anti-inflammatory drugs, he said. “We just forget doses… and it matters.”
The International Association for the Study of Pain holds a conference every three years in a different country. The main topics at the 2002 conference, which ended yesterday, included new medications, treatment of pain in the elderly, the psychology of pain and the use of medical marijuana.
After decades of neglect, pain has become one of the hottest topics in medicine over the last five years. Many doctors, nurses and hospitals are responding to criticism that they don’t do enough to relieve pain, a notoriously difficult symptom to understand and treat.
Among other things, many hospitals now routinely measure the self-described pain level of patients — the so-called “fifth vital sign” — along with pulse, respiration rate, blood pressure and body temperature.
However, painkillers still have side effects. Opium-based drugs, like morphine and OxyContin, are powerful but can cause addiction. And non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen can cause gastrointestinal bleeding, a potentially fatal condition in fragile patients.
Some doctors fail to realize the drugs can also hurt the hearts and kidneys of patients, McQuay added. “We have this kind of blinkered approach in our medical teaching and training. You could ask any health-care professional what the non-steroidals do, and they’ll say they make your guts bleed. But the cardiac effects may be just as important.”
The COX-2 inhibitors appear to be less risky, but they can spell trouble, McQuay said.
In an interview, another pain specialist said some doctors do indeed neglect the risks of non-steroidal painkillers. However, like McQuay, he said doctors shouldn’t abandon the drugs but instead use them with care.
“It’s generally perceived that the non-steroidals are very safe given the fact that you can even buy them over the counter without a prescription,” said Dr. Bill McCarberg, director of the chronic pain management program for the Kaiser Permanente health plan in San Diego. “But in reality, there are risks related to their use.”
Patients should be especially vigilant about letting their doctors know when they take over-the-counter painkillers, McCarberg said. Otherwise, doctors may inadvertently cause a potentially serious drug interaction.
Doctors must take special care when prescribing drugs for the elderly, McQuay said at the pain conference.
“As the population ages, we’re going to have a lot more older people,” he said. “And older people have other medical problems, too. Many of our pain patients are taking eight medications on average. So, if we put in another medicine, we’re likely to be causing ripples in the pond.”
But McQuay also acknowledged that his advice is only based on current medical knowledge. “I’m acutely aware that everything I say will have to be changed in two or three years’ time,” he said.