NSAIDs – better and worse than we thought

As the Cox-2 debate continues, other NSAIDs (nonsteroidal anti-inflammatory drugs)are coming under the microscope.  And guess what?  There’s good news and bad news.

NSAIDs are still safer than many other drugs, as far as we know.  But there is increasing concern about some of the heart risks, even in "traditional" NSAIDs, on top of the concern about stomach problems.  It’s all a good reminder that even though a drug may be "generally safe", that doesn’t mean you can take it as much as you want and not do damage.

There is good news, however.  Rami Burstein, an associate professor at Harvard Medical School and vice chairman of research of the Department of Anesthesia and Critical Care at Beth Israel Deaconess Medical Center authored a study on use of NSAIDs for migraine in the emergency room.  The conclusion of the researchers was that intravenous NSAIDs (ketorolac – brand name Toradol) were as effective (if not more) as the narcotics that are often given to migraineurs.  Compared to the narcotics, the NSAIDs are considered to be safer and are also less habit forming.  But the dosage had to be intravenous to properly work on the nervous system.

According to a 1998 study, over half of migraineurs are given narcotics without even being told of their other choices.  There are more and more options, most of them safer.

The patients in Burstein’s study had allodynia – a hypersensitivity of the skin that often occurs with migraine.  Previous studies indicate that triptan class drugs aren’t very effective in these cases.  64% of patients were pain free within an hour of getting the ketorolac.  The others all had a history of using opioids.  “This immediately raised a red flag regarding treating migraine patients with opioids, which we believe is wrong practice,” Burstein said.  May this be another step to better treatments.