Various studies have indicated that as many as 30% of patients taking NSAIDs develop gastroduodenal ulcers.
How Safe Are NSAIDs?
Nonsteroidal anti-inflammatory drugs (NSAIDs) have become a standard treatment for many problems relating to back pain. They are prescribed and taken with little or no concern for side effects or problems.
A recently published study in the Annals of Rheumatic Diseases1 had this to say about NSAIDs:
"The magnitude of the problem of NSAID-induced side effects is illustrated by the fact that 25% of all reported adverse drug reactions in the United Kingdom are due to nonsteroidal anti-inflammatory agents, although these drugs comprise only 5% of all drugs prescribed. The primary safety concern with NSAIDs is the increase in serious gastrointestinal damage, including ulceration, haemorrhage, and perforation."The paper explains further:
"In the stomach and duodenum, nonsteroidal anti-inflammatory drugs inhibit endogenous prostaglandins that play a role in maintaining mucosal defence mechanisms. Various studies have indicated that as many as 30% of patients taking NSAIDs develop gastroduodenal ulcers."The paper pointed to significant differences in the development of gastroduodenal ulcers of three commonly prescribed NSAIDs.
"For patients who had pre- and post-treatment endoscopic examinations, gastroduodenal ulcers developed in 3 (1.5%) of 200 patients treated with diclofenac/misoprostol, 21 (10.3%) of 204 piroxicam-treated patients, and 17 (8.6%) of 198 patients receiving naproxen (Chisquare = 13.771, p=0.001)."The paper concluded:
"Diclofenac/misoprostol at twice daily dosing is associated with significantly fewer gastroduodenal ulcers than either piroxicam or naproxen. The efficacy of diclofenac/misoprostol in treating the signs and symptoms of osteoarthritis is at least comparable to that of piroxicam and naproxen.While you would prefer that your patients not use NSAIDs, if they insist, you can be instrumental in steering them away from those that are potentially most harmful.
Reference
1. Gomes JA Melo, Roth SH, Zeeh J, Bruyn GAW, Woods EM, Geis GS. Double-blind comparison of efficacy and gastroduodenal safety of diclofenac/misoprostol, piroxicam, and naproxen in the treatment of osteoarthritis. Annals of Rheumatic Diseases, 1993;52:881-885.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
