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The effect on Osteoarthritis
Could it be that the massive widespread use of
NSAIDS (non-steroidal anti-inflammatory
drugs (research paper at
prolotherapy.org) twenty and thirty plus years ago is the reason
that there is currently an epidemic of disabling
osteoarthritis
resulting in a slew of spine and
joint
replacement
operations?
By 1983, five of the 50 drug products most often dispensed were NSAIDs,
representing over 4% of the total prescription market. The number one
use for these NSAIDs in 1983 was osteoarthritis. While the prescribing
patterns for specific NSAIDs have changed over the years, as drugs like
ibuprofen and naproxen became available over-the-counter, an NSAID is
still the number one medication prescribed by physicians for
osteoarthritis.
For instance, 80% of rheumatologists noted they frequently prescribe
NSAIDs for symptomatic
hip and
knee osteoarthritis, while for the same
group of clients, 65% of primary care physicians use an NSAID. Even when
physicians were educated on guidelines based on the European League
Against Rheumatism, American College of Rheumatology, and The Arthritis
Society guidelines for OA treatment, limiting NSAID use, NSAIDs were
still prescribed over half the time for patients with knee OA.
These prescribing patterns are confirmed in the numbers. For instance,
in 2002, the prescriptions for generic ibuprofen and naproxen exceeded
500 million per year, with over 45 million prescriptions written for
cyclooxygenase-2 (COX-2) inhibitors.
Realize, these numbers do not include all of the over-the-counter NSAIDs
that have been consumed over the last thirty plus years. According to
the National Consumers League survey conducted in 2002 on the public’s
use of and attitudes toward NSAID medications, 83% of the respondents
had used an over-the-counter pain medication, with 15% using it daily.
When this survey was combined with The Roper National Survey of the
over-the-counter pain reliever users, 38% used both prescription and
over-the-counter pain relievers, and 44% consumed greater than the
recommended dosages. The average length of the prescription drug use was
6.6 years.
In respondents who had
arthritis pain, 85% used over-the-counter pain
relievers. What this data means is that 36 million Americans are using
over-the-counter pain medications daily, with roughly 23 million using NSAIDs. Other surveys have confirmed that a high percentage of the U.S.
population (17% or greater) routinely uses over-the-counter NSAID
medications.
In a study of 2433 patients attending an outpatient physical therapy
unit, 79% reported using either over-the-counter or prescription
anti-inflammatory pain medication during the week prior to the survey.
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In data that we have published concerning unresponsive neck,
knee, hip, and temporomandibular joint pain, the average
person experienced pain for over five years and was taking
one or more pain medications at the time of their first
Prolotherapy visit. |
This epidemic NSAID prescribing and consuming for
osteoarthritis is seen
in most developed countries where 20-30% of elderly people (age>64
years) with up to 40% of some populations receiving NSAIDs.
The question begs to be asked, “Could the use of these NSAIDs be the
cause of the incredible rise of osteoarthritis and need for subsequent
musculoskeletal surgeries, such as knee and hip joint replacements?”
For more information
Linsell L, et al. Prospective study of elderly people comparing
treatments following first primary care consultation for a symptomatic
hip or knee. Family Practice. 2005;22:118-125.
Hochberg MC, et al. Preferences in the management of osteoarthritis of
the hip and knee: results of a survey of community-based rheumatologists
in the United States. Arthritis Care and Research. 1996;9:170-176.
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