American Heart Association on pain control*

Cardiologists have launched a save-the-heart-and-bear-the-pain campaign. Their cardiocentric viewpoint may leave those of us at risk for heart disease sidelined with aging, aching joints.

The AHA just issued new guidelines discouraging the use of COX-2 inhibitors such as Celebrex in heart patients or even those at risk for heart disease. Noting that these drugs increase sodium retention, decrease blood flow to the kidneys, and increase blood pressure, they encouraged non-drug treatments such as weight loss and physical therapy as the first-line defense against musculoskeletal pain.

If these measures are 'too little too late,' they recommended reaching for tylenol, tramodol, or narcotics before considering the so-called NSAIDs (non-steroidal anti-inflammatory drugs). Of all these various drugs (ibuprofen, piroxicam, etodolac and others), they endorsed naproxen (OTC Aleve) as cardiac neutral.

In the real world of aching joints holding up aging hearts, these guidelines create as many problems as they seek to avoid. There's obviously no losing weight without exercise, and there's no exercising while the arthritic knees are screaming. Naproxen may be cardiac neutral, but I just sent a middle-aged lady to the ER yesterday when she began passing blood clots instead of stool after five days on this drug. And another sixty-something patient in the midst of training for a triatholon is hobbling instead of running now that she's off NSAIDs and on blood thinners for intermittent atrial fibrillation.

Cardiologist Dr Scott Solomon of Brigham and Women's Hospital summed up the broader picture:

Physicians need to weigh any potential cardiovascular risks of nonselective NSAIDs together with the clear increased risk of GI bleeding against risk of abuse with narcotics.

*Information from AHA updates NSAID advice