NSAIDs and Opioids May Not Work for Pain!

by Chris Centeno, MD /

nsaids and opioids

As if we needed yet another reason to just say no to NSAIDs and opioids, it seems that some of them just aren’t working. So while you may be getting a lot with these drugs—the risk of sudden-death heart attacks and strokes and GI bleeding with NSAIDS, and addiction and more pain with opioids, for starters—there is one thing you may not be getting in return: pain relief.

Before we review today’s supporting literature, let’s review NSAIDs and opioids and why these are such bad-news drugs.

Why You Should Say No to NSAIDS

Some NSAIDs, such as meloxicam (Mobic) and celecoxib (Celebrex) require a prescription, but the ones you are probably more familiar with are those you can buy right off your drug-store shelf: ibuprofen, Advil, Motrin, naproxen, Aleve and so on. Whether off the shelf or behind the pharmacist’s counter, all NSAIDs increase your risks of serious side effects. The thing that sets NSAIDs apart from just a normal pain reliever, such as acetaminophen, is that is also tackles inflammation; however, if your inflammation is acute and not chronic, the inflammation is the body’s natural reaction to attempt to heal itself, so it’s not typically a good idea to stop that process with NSAIDs.

The list of NSAID side effects is long and just keeps growing. The links between NSAIDs and heart failure are numerous. One recent study showed an increase in heart-failure hospital admissions when the patients are taking NSAIDs. Another one showed that within five years of a heart attack, NSAID use increased the risk of another heart attack. There is also the disturbing conclusion showing that depending on the NSAID, heart-attack death is increased by up to 407%. And we now know heart-attack risk isn’t just limited to long-term use of NSAIDs; just one week of NSAID use can increase the risk of a heart attack by 50%!

Check out these other risks of NSAID use as well:

NSAIDs can also be addicting, so it’s a good idea to get off of them sooner rather than later.

Why You Should Say No to Opioids

Opioids are prescription narcotic pain relievers, such as Percocet, Lorcet, morphine, hydrocodone, and Demerol. The CDC has reported that there is an epidemic of opioid overdose in the U.S., and while that includes illegal opioids, such as heroin, they report that nearly half of these overdoses are due to prescription opioids. So the risk of addiction and overdose is certainly a strong reason to say not to opioids.

More reasons? Not only are certain opioids not relieving pain, we also know these narcotics can actually amplify pain by indirectly creating inflammation in the spinal cord, leading to chronic pain. So opioids can actually cause more pain in the long run than the pain they are supposed to prevent. Similarly, if you are considering a knee replacement and you’ve taken even just a single prescription of opioids within two years prior to your surgery, you are at a higher risk for increased pain after surgery.

New Study: Protein Receptor NK1R

The new study out of Australia set out to research why certain pain medications may not work for everyone. When we encounter a painful stimulus, a paper cut for example, protein receptors on our cell surfaces send the signal to our brain that we are in pain. Pain medications can block these signals from the cell surface. The study focused on a specific protein receptor called NK1R that is stimulated by pain. However, they discovered that NK1R is sly—when pain activates it, it slips inside the cell membrane, effectively shielding itself from the effects of pain medication (which can’t penetrate the cell surface). The protein, therefore, is able to continue signaling pain.

The upshot? If your pain medicine doesn’t seem to be working, that sneaky NK1R protein may be the reason, and the risks certainly aren’t worth it when your pain medicine isn’t actually working. After additional studies, researchers are hoping to use these results to create more-effective pain medications that don’t carry the dangerous risks of NSAIDs and opioids, so we’ll follow this if it happens.

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11 thoughts on “NSAIDs and Opioids May Not Work for Pain!

  1. Anna Freye

    Dear Mr Centeno,
    Your stem cell treatment for restoring cartilage sounds absolutely wonderful and, as I have multiple allergies, the use of my own stem cells would prevent any problems. Could you tell me, please, if I would be suitable for this treatment? I have Ehlers-Danlos Syndrome, Hypermobility Type III as well as early onset osteoarthritis which is now advanced. I have very little cartilage in my spine, neck and shoulders and no knee cartilage left. I have lots of spurs which have, helpfully, fused the joints in my neck and upper spine. I have frequent subluxations from the EDS and the pain from the combination of both conditions is terrible. I have a CYP enzyme mutation so most painkillers don’t work on me. Morphine doesn’t work at all, it just keeps me awake and makes me feel very agitated. Celebrex does help reduce the pain to some extent and CoProxamol helps slightly as does Gabapentin. I use magnesium flakes in the bath and take Vit D and calcium. Effective painkillers, such as Fentanyl, have caused me to stop breathing which has been alarming, so I have had to stop using them. Mast cell activation is a part of EDS although, maybe, the problem with Fentanyl is inherent with this type of medication.

    If I would be suitable for stem cell treatment, could you tell me, please, if there are any trials in the UK that I could be a part of? My Rheumatologist is Dr Alan Hakim in London and I’m sure he would be very supportive.

    Thank you for all the very helpful information on your site.

    Many thanks, Anna. (Freye).

    1. Regenexx Team Post author

      Anna,
      Unfortunately, we are not aware of any clinical trials in the use of stem cells in EDS patients in the UK. While EDS patients take longer to heal and need treatment more frequently, we’ve treated joint instability and joint injuries in EDS patients with both stem cells and platelet procedures with good results. Because unlike Classic and Vascular EDS many different mutations can be responsible for Hypermobility type EDS, one needs to experiment with what will work in each individual case for pain and inflammaton. Good quality fish oil containing 2,000-4,000 mg of EPA a day can be helpful. Many patients have found Turmeric/ Curcumin complex with Bioperrine to be especially helpful. We are in discussion with a Physician in the UK in reference to becoming a Regenexx provider and will update you if and when updates become available. Both the Regenexx Tumeric/Curcumin and Fish Oil are avialable on Amazon UK.

  2. Gregory Meister

    I take 1 advil for my back maybe every other day So what am I supposed to take for pain if you can’t take that?

    1. Regenexx Team Post author

      Gregory,

      Studies have shown and we’ve found that Curcumin with Bioperrine and good quality fish oil are effective for inflammation and pain. Please see: https://regenexx.com/blog/nsaid-addict-can/

  3. Evinx

    Is there any research showing stem cells being effective for cervical dystonia (Torticollis)?

    1. Regenexx Team Post author

      Evinx,
      Torticollis can be caused by cervical disc/vertebrae issues, which can be treated. Very specialized platelet procedures would be more commonly used, but stem cells, if needed. Please see: https://regenexx.com/blog/want-see-advanced-image-guided-injection-step-procedure-suite-dr-pitts/ If you would like to see if your specific situation would be a good Candidate for a Procedure, please submit the Candidate form.

  4. Jim Patek

    Dear Regenexx
    My body seems to be riddled with arthritis and I have used NSAID’s when the going got tough. And still do occasionally. My comment is that I really appreciate the updates on research into NSAID side effects because it makes me think twice about taking this drug. As in, “is my pain really that intolerable” or am I taking this pill because I know I will feel better than I do now even though the irritation is tolerable. I am taking the supplements recommended but they do not always “do the trick.” Thanks.

    1. Regenexx Team Post author

      Jim,
      That is wonderful news! The effect of the supplements tends to increase with time.

  5. Merrilyn Jones

    I have failed neck syndrome, after two surgeries in 1994 to remove disc c6-c7 and replace it with bone from my hip. Somehow the bone disappeared and the surgery was redone ten days later using more bone from my hip and securing it with a plate and 4 screws. I was diagnosed with fibromyalgia in 1996. I refused the diagnosis at that time but later accepted it and am treated by a board certified rheumatologist and a board certified pain clinic. I have taken nearly every nsaid, both otc and prescription. Meloxicam is a wonderful drug that works well for me. I have tried several times to stop taking it, but find the resulting pain and quality of life without it is horrid! I also take oxycontin and tramadol. As a result, I am able to work and enjoy activities that I would be unable to do without these drugs. I have used fish oil in the past at very high doses with no results. I read your newsletters and wanted you to know that these drugs work for me and without them, I would be unable to get out of bed in the mornings! I will try the supplements that you suggest in hopes that they will help and I can decrease or stop my other medications. Thank you for all the great info you provide.

    1. Regenexx Team Post author

      Merilyn,
      In medicine Risk always needs to be balanced against Benefit. Long term use of opioids like Oxycontin and Tramadol cause chronic pain and central sensitization, https://regenexx.com/blog/narcotics-cause-chronic-pain-no-surprises/ and even a 30 day course caused addiction in 45% of cases in a recent study. It would not be expected for fish oil or other supplements to work unless the other medications were removed from the equation. It’s great that your current regimen has allowed you to do things you need and want to do as that is incredibly important. At some point, though, you might consider a second opinion on whether there is an alternative solution in the risk vs benefit equation.

  6. Bridgette

    As Pete Egoscue says, “Think of pain as the body’s own built in car alarm.” “Rediscover the body’s design; restore function; return to health.”

    Better Alterntive to NSAIDs are Essential oils. Make sure you get a good quality product, 100% pure, and that the Latin name is on the label. There are great beginner books and some Rec Centers have Essential oil classes. Dr. Josh Axe has some great tips on pinterest!
    Muscle soothing- Deep Blue, Marjoram, White Fir, Eucalyptus, Clove, Lavender, Thyme, Ginger
    Sprains/Strains- Ginger, Thyme, Lavender, Chamomile
    Inflammation- Eucalyptus, Frankincense, Lavender
    Pain- Frankincense, Marjoram, Rosemary,Sandalwood, Wintergreen

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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