The most commonly prescribed medicines in my orthopaedic clinic are probably some of the newer NSAIDs, like Celecoxib (Celebrex) and Etoricoxib (Arcoxia) .
Our bodies contain an enzyme (a natural chemical) called Cyclo-Oxygenase (COX) which plays a big role in inflammation (pain, swelling, redness etc).
NSAIDs like Celebrex and Arcoxia work by blocking this enzyme (COX), and so they reduce inflammation (Very good).
But - just like your boss makes you wear many hats at the office - to make our bodies more efficient, COX wears many hats - it plays different roles, like protecting the inside of our stomach and intestines, and the arteries that supply our heart and brain, so when COX gets blocked, some people may get stomach ulcers, bleeding from the stomach or intestines, heart problems and even strokes (Very bad).
With older NSAIDS (like Voltaren/ Diclofenac), this was a major problem. Newer drugs like Celebex and Arcoxia are designed to reduce these bad effects, but for people who have bad gastritis, stomach ulcers, and heart problems, they can still be dangerous. This is why NSAIDs are sometimes given together with medicines to protect the stomach (e.g. Ranitidine, Omeprazole)
(NOTE: The solution, however is NOT to take a stomach protector with every NSAID. While commonly practiced, this can play havoc with your stomach juices. Unless you have previously had severe gastritis or a stomach ulcer, it's best to take NSAIDs after a meal and save the stomach protectors for if they are really needed.)
II
Many worry their kidneys will spoil if they take NSAIDs.
'Doc, I 'die - die' also don’t want to take pain medicine, '
‘Kalau makan nanti buah pinggang rosak, kan, Doktor?'
It’s true -if you take an NSAID every day for many months or years, you may develop kidney problems. However, in most cases (e.g. in knee osteoarthritis), you only need to take NSAIDS for one to two weeks when you have a worsening of pain (we call this an exacerbation –or flare-up – of knee osteoarthritis). Short courses of NSAIDs are safe even up to a few times a year.
This does not mean that we should take NSAIDs for fun, or anytime we have a mild pain for a few hours. But when your surgeon prescribes analgesics or anti-inflammatory medicines (the two are different), there may be a good reason behind it.
(The good reason being the damage done to your inflamed joint is dramatically slowed - and you will be able to walk and move around faster, which prevents the terrible health problems that arise when you are confined to a chair or bed)
There’s a reason we say to live is to keep moving!
Always remember to check with your friendly orthopaedic surgeon or doctor before taking any medicines. If you know or suspect you have a stomach/intestinal, heart or kidney problem or have had a stroke, TELL your doctor before starting any medicines.
Next in this series :
Pain is such a …. Pain!
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