We are thirsty in the rain. We have too much medical care and not enough “health” care.
This is the second in the series of Too Many Too Many’s and today we would like to highlight the overutilization of non-steroidal anti-inflammatory drugs (NSAIDs) both medically prescribed and self-prescribed. More than 70 million prescriptions for NSAIDs are written each year in the United States. With over-the-counter use included, more than 30 billion doses of NSAIDs are consumed annually in the United States alone. Let me restate that 30 Billion with a BIG B! That is a remarkable testament to the liver and kidney function of US citizens. Unfortunately, maybe it is not.
NSAIDs are implicated in nearly 25% of all adverse drug reactions, with the most commonly reported effects being GI irritation. NSAIDs increase the relative risk of GI hemorrhage by approximately three-fold, although estimations as high as 10-fold have been reported in the literature.
The second most common type of adverse effect occurring with NSAID use involves the renal system. NSAIDs are commonly known to cause acute kidney injury (AKI) through multiple mechanisms, accounting for 16% of all drug-related renal failure. Besides producing a reversible renal failure, NSAIDs are known to cause acute interstitial nephritis (AIN) with hematuria, proteinuria and flank pain as well as acute tubular necrosis (ATN).
In our region of the country, endurance athletes are common. NSAID use is widespread among this athletic population particularly in marathon and ultramarathon running. It is estimated that as many as 75 percent of long-distance runners take ibuprofen or other NSAIDs before, during or after training and races. This is alarming in light of a recent study, which noted increased rates of acute kidney injury in endurance runners who took ibuprofen. The authors used creatine levels as a surrogate marker of acute kidney injury but the results remain pretty convincing. The authors also reported a number needed to harm (NNH) of 5.5.
Meaning for every 5-6 runners taking ibuprofen one would have renal injury.
Given that the number one reason individuals access physical therapy is for painful conditions it is imperative that we have honest conversations with our clients on their NSAIDs usage and their knowledge and understanding of the potential side effects. I am consistently amazed at the level of use of these drugs whether prescribed or over the counter. We need to be part of the conversation and begin decreasing the use and volume of use of NSAIDs in this country.