COX-2s suggested as last resort

NEWS IN BRIEF — Posted March 19, 2007

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In response to the growing body of evidence linking nonsteroidal anti-inflammatory drugs to an increased risk of cardiovascular and cerebrovascular disease, the American Heart Assn. published a scientific statement last month in the online edition of Circulation recommending that COX-2 inhibitors become a last resort for patients with known heart disease who need amelioration of chronic pain.

The authors are calling for nonpharmacologic approaches such as physical therapy and hot or cold packs. If these efforts do not work, the least-risky medications should be considered. COX-2 inhibitors should be used only for the shortest amount of time at the lowest dose possible. Long-term use of pain relievers, even over-the-counter medications, should be done only in consultation with a physician, the authors said.

"Some physicians have been prescribing the new COX-2 inhibitors as the first line of treatment," said Elliott M. Antman, MD, lead author and professor of medicine at Harvard Medical School in Boston. "We are turning that around and saying that, for chronic pain in patients with known heart disease or who are at risk for heart disease, these drugs should be the last line of treatment."

Adding to the evidence that some pain relievers may not be good for the cardiovascular system, a study in the Feb. 26 Archives of Internal Medicine found that men who regularly take nonnarcotic analgesics such as aspirin, acetaminophen and NSAIDs are more at risk for hypertension.

Note: This item originally appeared at

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