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Another Painkiller Busted-What Do You Do Now

by Dr. Marcus Laux

Published 02/03/09

By now you must surely have seen or heard the news of the withdrawal of the painkiller Vioxx (rofecoxib) from the market. It joins a growing list of painkillers that are being found to be potentially harmful. It also joins the ranks of drugs withdrawn on the basis of serious public health risk. Increasingly, medical care and the pharmaceutical control of it—and thus our health—are placing profit above safety. If you’ve been using Vioxx, your obvious question is, “How can I control my pain?” To answer that question, it helps to know a bit about the pain process.

What’s Happening Inside

Pain is often the result of an inflammatory response in the body. This is especially true in arthritis, and painkiller drugs have for many years targeted the inflammation pathways in the body. A significant chemical family is known as cyclooxygenase (COX), with two branches: COX-1 and COX-2.

Back in the 1960s, aspirin-based drugs were touted as state-of-the-art palliatives for arthritis. But, as you probably know by now, aspirin carries some risk, not the least of which is gastrointestinal bleeding. Aspirin is what is known as a non-selective inhibitor, meaning that it affects both the COX-1 and the COX-2 pathways. The COX-1 enzyme supports the gastrointestinal lining, so anything that blocks COX-1 leaves the stomach vulnerable to attack from its own acids. The COX-2 enzyme, on the other hand, is the dominant enzyme at the site of inflammation, and has very little activity in the stomach, kidneys, or platelets.

In theory, a drug that blocked only COX-2 would limit inflammation (and therefore pain), without the GI side effects. It should also be good for the heart, because COX-2 inhibits thrombosis. Practice hasn’t matched theory, however, as the current situation shows. So before you take a synthetic prescription painkiller, first try a natural approach to address your concern. One thing to bear in mind is that, in general, natural solutions work more slowly than synthetic drugs, so they require a bit of patience, but the long-term benefits more than make up for that; they are much safer, and over time your relief can be greater than with the drug.

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