For many, relief from chronic pain worth risk

Painkillers still popular despite warnings, bans

April 11, 2005|By Bruce Japsen | Bruce Japsen,CHICAGO TRIBUNE

Despite sweeping new warnings that the nation's most popular painkillers can harm hearts, stomachs and skin, many Americans are going to go right on taking them, saying the relief is worth the risk.

The popular arthritis drug Bextra last week became the second Cox-2 painkiller pulled from the market while the Food and Drug Administration pinned its highest warnings on Celebrex and nearly 20 other common prescription-strength drugs such as Mobic, Motrin, Naprosyn and ibuprofen.

The move tainted trusted remedies and replaced them with nothing but confusing alternatives, prompting many patients to count pills and ration what's left of medications that have worked for them.

"My mother has a basket full of Vioxx under her bed and won't get rid of it," said Dr. Victoria Brander, director of the Northwestern Arthritis Institute in Chicago. "Patients worry about pain. They are worried about long-term risks, but many are willing to make that trade-off."

One of those willing to risk it is Bob Starzyk, a 51-year-old truck driver from Palos Heights, Ill., who says he occasionally needs Vioxx -- pulled from shelves in September after reports that it increased the risk of heart attacks -- to do his job.

"I have maybe 15 to 20 left. ... I will take the risks to get relief," Starzyk said. "I still have Vioxx at home, and when I get really bad I take it to keep the pain away. You can only deal with pain so much."

Starzyk is among the estimated 75 million Americans -- one in four -- who are living with chronic pain, according to the National Pain Foundation.

With so many seeking relief -- which can be a long trial-and-error process to find the right medication -- physicians continued writing prescriptions for Cox-2s, even after an FDA advisory panel in February warned all drugs in the class had the same safety problems.

And as similar warnings also were slapped on the older remedies known as nonsteroidal anti-inflammatory drugs, or NSAIDs, prescriptions are still being written for those, too. NSAIDs were the standard pain medication until Cox-2s were introduced and marketed as easier on the stomach.

Since Oct. 1 -- the day after Merck & Co. pulled Vioxx from the market -- through the end of February, daily prescription volume for NSAIDs has fallen less than 5 percent at pharmacies operated by the nation's largest drugstore chain, Deerfield, Ill.-based Walgreen Co.

"The change is not a lot considering what's all happened," said Walgreen spokesman Michael Polzin. "It seems people who have gotten good results ... want to continue with it."

High demand for pain relievers is a key reason why neither Pfizer nor Merck is ruling out bringing Bextra or Vioxx back on the market. The companies realize that the Cox-2 drugs, a class that also includes Celebrex, have risks, but they are discussing options with the FDA.

Although the companies are not specific about their plans, analysts and some doctors say limited use of Celebrex, as well as controversial pain pills like Mobic and other nonsteroidals, should be safe.

Doctors say they are closely monitoring patients while weighing risk factors such as obesity, diabetes and high blood pressure. Some physicians are telling patients to take a lower dosage to see whether that alleviates the pain.

An FDA advisory panel said lower dosages of Vioxx, Celebrex and Bextra were the safest, while noting increased risks of heart attack and stroke, particularly at higher dosages. Some doctors are also advising patients to take low dosages of NSAIDs, such as two tablets of over-the-counter Advil.

There are many pain remedies that were not affected by the FDA's warnings. Tylenol, for example, is a first-line treatment for osteoarthritis and is generally not perceived as harmful to the stomach. For more serious pain, there are such prescription remedies as codeine and tramadol.

The Chicago Tribune is a Tribune Publishing newspaper.

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