Dr. John Day, Cardiologist

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Which Pain Medications Are Safe For the Heart?

“What is there left for me to take for my back pain?” My patient Mary asked after the recent FDA warning that common pain medications, like ibuprofen and Aleve, increase the risk of heart attacks and strokes.

Fully, 100 million Americans suffer from chronic pain.  Are you one of them?

In this article I discuss the life-threatening cardiac risks of traditional pain medications.  I also share 9 heart healthy pain treatment strategies based on the latest scientific studies.

NSAIDs Like Ibuprofen and Aleve

The non-steroidal anti-inflammator medications (NSAIDs), like ibuprofen and Aleve, are the classic “go to” medications for people suffering from pain.  The problem is that ever since the Vioxx experience, in which an estimated 140,000 people suffered a heart attack from this medication, we have known that you put your heart and brain at risk each time you take one of these medications.

Even the safer NSAIDs, like ibuprofen and Aleve (naproxen), may increase the risk of a heart attack and stroke.  Indeed, taking ibuprofen increases the risk of a heart attack by 14% and strokes by 11%.  NSAIDs also increase the risk of a dangerous heart rhythm, called atrial fibrillation, by 33%.

In addition to these cardiovascular risks, NSAIDs also raise your blood pressure and increase your risk of bleeding, heart failure, kidney failure, and ulcers.

Aspirin

While aspirin is considered a NSAID, it stands out as possibly the only pain medication that appears to be safe for the heart.  Aspirin was once felt to prevent heart attacks and strokes, however, more recent research is challenging this long held belief.  This new research has led the FDA to announce in 2014 that aspirin was no longer recommended for the general public to take in order to prevent heart attacks and strokes.

While aspirin has long been felt to be “safe,” it can also cause serious side effects like bleeding and ulcers. For example, in one large study, there was a 1 in a 100 risk of major bleeding each year in people taking an aspirin daily.  This risk of bleeding, from any of the NSAIDs, is of particular concern for people who may be on other blood thinners.

Acetaminophen

Like aspirin, acetaminophen was once felt to be a safe medication.  However, even this medication is linked to an increased risk of heart attacks and strokes.

This risk appears to be similar to that of NSAIDs.  In addition to the increased heart attack and stroke risk, this medicine can also raise your blood pressure and cause liver damage.

Opiate Medications

According to the CDC, there are 259 million prescriptions written each year for narcotics in the U.S.  If you break this down, that is nearly one bottle of narcotic pain pills for every person in the United States.

These narcotics cause countless cardiac arrests through prolongation of what is called the “QT” interval on the ECG.  It is for this reason that many opiates, such as Demerol and Darvocet, have been taken off the market.

What Can I Take For Pain?

At this point you are probably wondering, what can I take for pain?  Unfortunately, there is no “free ride” when it comes to managing pain with traditional medications.  As with everything, you and your physician have to carefully weigh the risks versus benefits of everything that you take.

For example, I love to exercise hard.  However, at age 48, occasionally I will have pain from a pulled muscle or from a fall while skiing.   When this happens, I take 220 mg of naproxen (Aleve).

As a cardiologist, I am very aware of my increased risk of a heart attack, stroke, atrial fibrillation, or heart failure on the days when I take this medication.  However, I also have to balance these risks with the potential benefit of exercise.  To keep these risks at a minimum, I only take a very low dose (220 mg of Aleve) on the days that I experience significant pain.

Heart Healthy Pain Treatment Strategies

For those who suffer from chronic pain, you may want to explore alternative pain therapy to decrease your cardiovascular risks associated with the traditional pain medications.  Below are some possible alternative pain treatments to discuss with your physician.

1. Maintain a Healthy Body Weight

As with everything, “an ounce of prevention is worth a pound of cure.”  For most people, getting down to a healthy body weight would resolve a large portion of the pain they experience.  I know that this was critical for me to resolve my chronic back and knee pain.

2. Turmeric (Curcumin)

If you enjoy Indian or Asian foods then you have undoubtably eaten this spice before.  It is also found in curry.  Turmeric or curcumin has very potent anti-inflammatory properties.

Indeed, in one large study turmeric (curcumin) was shown to be just as effective in reducing pain, with a lot less side effects, when compared to ibuprofen for people suffering from arthritis.  In my own experience, I have not found turmeric (curcumin) to be as effective as low-dose Aleve but it does seem to help with relatively minor aches.

An additional benefit of turmeric (curcumin) is that it may also help to prevent cardiovascular and Alzheimer’s Disease.  Perhaps this explains why the risk of dementia is 4.4 times lower in India when compared to the U.S.

3. Capsaicin

Capsaicin is the active component of chili peppers.  While eating peppers may help with pain, the most potent effects seem to be from using capsaicin topically.  Indeed, many studies have confirmed the potent pain relieving effects of topical capsaicin for the use of arthritis or nerve pain.

Even though capsaicin is a completely natural product, side effects can occur.  For example, some people may experience severe skin reactions.

If you like to eat red peppers or chill peppers, capsaicin has also been shown to increase metabolism and help to burn fat.  Thus, not only may your pain decrease but you may also lose weight.

4. Omega 3 Fatty Acids

While oily fish is not generally considered a “pain medication,” studies do support pain relieving effects with omega 3 fatty acids.  I suspect that this is due to the anti-inflammatory effects of omega 3s.  Even if wild Alaskan salmon does not help your pain, studies show that you have markedly reduced your overall cardiovascular risks.

5. Glucosamine and Chondroitin

Glucosamine and chondroitin have now gone “mainstream,” especially for the treatment of knee arthritis.  Both of these substances help to build or repair cartilage, especially in the knee.  Indeed, studies have shown that these can be just as effective as NSAIDs for pain and swelling with minimal side effects for most people.

6. Ginger

While also not commonly thought of as a “pain medication,” studies indicate that ginger may be another pain treatment option with minimal side effects.  Ginger is known to have anti-inflammatory effects which may help to prevent heart disease in some studies.

7. Yoga or Meditation

Studies have shown that yoga and meditation can be very effective “pain medications.”  As anxiety and depression amplify pain, I suspect that the primary effect of yoga and meditation is on our pain perception.  Regardless, both yoga and meditation have also been shown to help reverse or prevent heart disease.

8. Acupuncture

Acupuncture has been used for millennia in China to treat chronic pain and other health problems.  Modern studies have supported the pain relieving effects of acupuncture.  Fortunately, when done correctly, the cardiovascular risks appear to be very low.

9. Massage Therapy

Massage therapy can be very effective for musculoskeletal pain.  Another benefit is that it is also appears to be heart healthy.

Take Home Message

Unfortunately, all of the traditional pain medications can have life-threatening side effects.  When taking pain medications it is critically important to discuss the risks, benefits, and alternatives to these medications with your physician.

While some pain is unavoidable, many people can prevent or treat chronic pain through a healthy lifestyle which also includes anti-inflammatory foods, herbs, and spices as well as stress management.

Have you tried any of the 9 alternative pain treatment options discussed in this article?  If so, what was your experience?  Please leave your comments below to share with our community.