Aleve, Vioxx, Celebrex and Bextra: What You Need To Know About Arthritis Pain MedicationsRecent controversy about
safety of pain medications for arthritis has left patients and health care professionals alike confused about which medications are safe to use. In fact, a recent survey by Boston-based Rippe Lifestyle Institute indicated that many people with arthritis are suffering unnecessarily because they have stopped or reduced their use of pain relievers due to confusion about which drugs are considered safe.
The survey also showed that now, more than ever, those with arthritis need to understand benefits and possible side effects associated with all arthritis pain medications. In order to do so, people with arthritis, their caregivers and families must be familiar with recent news about two types of drugs most commonly used to treat arthritis pain – non-selective, non-steroidal anti-inflammatory drugs (NSAIDs), and another group of NSAIDs known as cyclooxygenase-2 (COX-2) specific inhibitors.
COX-2 specific inhibitors vs. Other NSAIDs
COX-2 specific inhibitors are newest members of NSAID class of medications. Available by prescription only, they became widely used in recent years to reduce joint pain and swelling. COX-2 specific inhibitors work by selectively blocking, or inhibiting, one of two enzymes associated with inflammation. Some experts think that this selective inhibition may be one reason for some of negative side effects currently associated with COX-2 specific inhibitors.
Non-selective NSAIDs were developed earlier than COX-2 specific inhibitors and have been widely used to relieve arthritis pain and inflammation for many years. Unlike COX-2 specific inhibitors, non-selective NSAIDs inhibit both major enzymes involved in inflammatory process, COX-1 and COX-2. The non-selective NSAID category includes a number of different medications that are available in both prescription and over-the-counter (OTC) products.
Timeline of Events
To understand current state of affairs, it is important to understand sequence of events. The controversy started when a study published in October 21, 2004, issue of New England Journal of Medicine cited COX-2 specific inhibitor, Vioxx as potentially causing “major adverse events,” including heart attack and stroke, among patients taking drug. As a result, Merck (the drug’s manufacturer) voluntarily withdrew Vioxx from market. However, in months following, safety of other available COX-2 specific inhibitors such as Celebrex and Bextra, as well as other arthritis pain medications in non-steroidal anti-inflammatory (NSAID) class, were also called into question.
Consequently, in February 2005, US Food and Drug Administration (FDA) convened a special Advisory Committee, made up of members of Arthritis and Drug Safety Advisory Committees, to review cardiovascular safety of these arthritis pain medications.
