2019-04-23 15:33:31
Often taken as self-medication for pain or fever, nonsteroidal anti-inflammatory drugs (NSAIDs)) are however drugs to be used with precaution and rarely in first intention.
NSAIDs do not relieve back pain
Osteoarthritis, arthritis, sciatica, painful periods, migraine, sprains, strains, tendinitis: the inflammatory pain are the first indication of these drugs. Nevertheless in case of low back pain, it seems pointless to rush to the box of ibuprofen: in 2017, a study published by Australian researchers showed that it only relieved one in six patients. For the others, the placebo did just as well. NSAIDs are still one of the first-line treatments for low back pain.
In self-medication, we start with paracetamol
The message from the health authorities is clear: always start with the paracetamol, in particular “in a context of pain and / or fever, especially in the event of a common infection such as angina, a dental infection or a cough”, indicates the ANSM (source 1). ” Well used, this painkiller is very safe, says Nathalie Richard, deputy director of analgesic drugs at the National Agency for the Safety of Medicines (ANSM). »
If the pain does not decrease after one or two days of treatment, one can then try to relieve it with a nonsteroidal anti-inflammatory drug, alone or alternately with paracetamol. NSAIDs should be prescribed “at the lowest possible dose and for the shortest possible duration “recalls the ANSM in a press release.
Some have cardiovascular risks
This would be particularly the case for diclofenac (Voltarene), available by prescription. A large Danish study, published in September 2018, showed that this molecule, taken orally, leads to an increased risk of serious cardiovascular problems (atrial fibrillation, stroke, heart failure, etc.), even in people with no risk factors. risk.
“This risk was already known, explains Nathalie Richard. The novelty is to have shown that diclofenac presents a 20 to 30% higher risk than other non-steroidal anti-inflammatory drugs, even at low doses (less than 100 mg per day), and over short periods of time. In fact, caution is called for: diclofenac is also contraindicated in people with cardiovascular disease or history.
Anti-inflammatories can make infections worse
Epidemiological studies carried out since 2002 suggest that these drugs increase the risk of infections such as shingles, chickenpox, pulmonary infections, angina or even ear infections. Not to mention dental infections. A risk confirmed by the Medicines Agency in April 2019: ibuprofen and ketoprofen have been reported to be responsible for serious infectious complications (neurological, pleuro-pulmonary infections, sepsis, etc.) leading to hospitalization. More recently, the ANSM warned of the fact that “several case of infectious complications of sometimes fatal outcome in adults and children who took nonsteroidal anti-inflammatory drugs (NSAIDs), on prescription or self-medication, were reported to us in March 2023 by regional pharmacovigilance centers (CRPV) (source 1). »
Suppressing inflammation also means suppressing a defense mechanism in the body, and this can promote infections, says Dr. Bernard Bégaud, professor of pharmacology at the University of Bordeaux.
In addition, pain relief can hide the signs of an early infection, delaying his treatment. “After two or three days of fever or persistent pain, anti-inflammatories should be stopped and a doctor should be consulted”, continues Dr Bégaud.
Be careful, if you suspect an infectious focus (dental abscess, angina, otitis), do not take anti-inflammatory! This risks masking the infection and delaying diagnosis.
They must sometimes be combined with a gastric protector
Even at normal doses, taking them exposes you to the risk of heartburn, even ulcer, perforation or gastric bleeding. As Dr. Bégaud points out, “this negative effect varies greatly depending on the anti-inflammatory and its mode of action. Some like the ketoprofen are less harmful to the cardiovascular system, but they have gastrointestinal side effects. I’ibuprofenl’aspirin and the diclofenac are less aggressive for the stomach. Hence the importance of swallowing them with a glass of water to prevent the tablet from sticking to the wall of the esophagus, and a snack or meal.
When NSAIDs are prescribed over several months and at relatively high doses, for example to treat pain from chronic inflammatory rheumatism, 15 to 30% of users risk developing ulcer disease. This is why the doctor associates them most of the time with a gastric protector of the type proton pump inhibitoras’omeprazole. “Despite listed or suspected negative effects, gastric protectors retain all their interest in this co-prescription”, emphasizes Dr Bégaud.
During pregnancy, medical advice is essential
In January 2018, the National Medicines Safety Agency recalled that one should not never use these drugs from the sixth month of pregnancy. The risk ? Injure the heart of the fetus at the stage where the two cavities of the organ separate, and this “even with a single take”, insists Nathalie Richard. The ideal is to avoid any self-medication throughout pregnancy.
If it is necessary to relieve a pain, one will use in priority the paracetamol“even aspirin as long as you are in the first two trimesters of pregnancy, but under medical supervision,” says Nathalie Richard.
Ibuprofen would disrupt the hormonal system
This is especially the case of sporty who use this molecule continuously to prevent muscle pains. However, takingibuprofen at a dose of 1200 mg per day for 6 weeks disrupts the secretion of sex hormones in the testicles in young men. This phenomenon usually occurs in 10% of older men. We still do not know the long-term consequences, especially on male fertility.
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