Seen the headlines about ibuprofen? A new study has linked the over-the-counter (OTC) drug with a 31% increased risk of cardiac arrest (where the heart stops pumping blood around the body).
Professor Gunnar Gislason of University of Copenhagen, who led the study which was published this week in the European Heart Journal, is calling for tighter control over ibuprofen use, saying: “Allowing these drugs to be purchased without a prescription, and without any advice or restrictions, sends a message to the public that they must be safe.”
This isn’t the first study that’s linked ibuprofen with heart risks; a study last year, in the British Medical Journal, associated the painkiller with higher rates of heart failure.
So what does all of this really mean for the general public?
How exactly does ibuprofen work?
Ibuprofen and paracetamol might sit next to each other on the pharmacy shelves, but they’re not the same thing. “[Ibuprofen] is a common painkiller but it’s also what we call a non-steroidal anti-inflammatory drug, an NSAID, and essentially that means we’re able to reduce inflammation within the body without having to use a steroid,” explains Dr Sara Kayat, of Dr Morton’s The Medical Helpline.
“Paracetamol is simply a painkiller, it doesn’t have the anti-inflammatory property. So whilst you can use [ibuprofen] for standard pains - for a stomach ache or a headache - it’s also very good in rheumatological problems, conditions where inflammation is a problem, [such as] arthritis and rheumatoid arthritis.”
Behind the headlines
It’s always worth keeping in mind that headlines don’t tell the whole story, and the findings of a study don’t automatically apply to the whole population, and there might be other important factors in the equation. In this case, the researchers in Denmark studied almost 29,000 patients who suffered an out-of-hospital cardiac arrest between 2001 and 2010, and also at how many of them had taken NSAIDs in the previous 30 days. The data led to the finding that associated ibuprofen use with a 31% increased risk of cardiac arrest (the risk rose to 50% for diclofenac, but this drug is no longer available over-the-counter in the UK and is less widely used).
This type of research’s known as a case-time-control study and the findings are considered very important. However, many of the people included in the data would have had other health conditions, and have been using other medications too – just two of many potentially important factors that may also come into play.
So should we be concerned?
“The most important point to take away from this study is to discuss all possible treatment options with your doctor, as well as the pros and cons of certain drugs, before you start taking any new medication,” says Dr Mike Knapton, Associate Medical Director at the British Heart Foundation.
“Although not all NSAIDs were found to be associated with increased risk of cardiac arrest, discussion with your doctor is imperative to make informed choices about the best treatment for you. For patients currently taking NSAIDs, including ibuprofen and diclofenac, the risks need to be reviewed and your specialist or GP will be able to advise on potential alternative treatments.”
Even drugs you can buy without prescription need to be used safely
Dr Kayat points out that just because certain drugs are available without prescription, all painkillers have side-effects, and it’s important your usage of them doesn’t go entirely unchecked. “We’ve always known ibuprofen to have side effects with regards to your stomach,” she says, noting that prolonged use can cause problems such as stomach inflammation and even ulcers. Therefore it’s important to have a conversation with your doctor if you are using ibuprofen a lot, so they can keep an eye on things and help you avoid potential side-effects.
“With regards to the cardiovascular risk, we need to be ruling out all the other risk factors that you may have so that we can lower your risk of cardiovascular disease whilst you’re taking [ibuprofen],” Dr Kayat adds. Long-term painkiller use can also end up causing worsened pain problems, such as chronic headaches.
Get your pain properly checked
Side-effects are not the sole concern, however. It’s also very important that any ongoing or worsening pain should be properly checked by a doctor, as you may need to be referred for tests, and there could be an underlying cause that you’re not aware of. “If you’re using [ibuprofen] regularly for a prolonged period of time, you need to be seeing your doctor so they can investigate any underlying cause of your pain or your inflammation,” stresses Dr Kayat.
“If you’re not getting relief from these painkillers, you need to be investigating whether there are any other underlying issues, so you need to be seeing your doctor.”
What else could you try?
There might be other solutions that could help relieve ongoing pain associated with inflammation. If pain’s severe, coming off drugs entirely won’t be an option for everybody, but these things might still help improve quality of life or reduce your reliance on drugs alone. Even something as simple as a warm bath, or a gentle swim or walk if you’re able, can help in both the short and long-term, as well as things like mindfulness meditation, and good nutrition, hydration and sleep, as well as making time for hobbies you enjoy.
“Physiotherapy tends to be a very good next step for things like joint and muscle pain. Also acupuncture might be good for back pain, we’ve found, and there are machine like TENS machines to help with nerve-ending pains,” says Dr Kayat. “There are all sorts of things that can help, or you might want to use them as an add-on so you can use less of the painkiller itself.”
Do you use ibuprofen regularly? Tell us in the comments below