下背痛用什麼藥？(acetaminohpen or NSAID?)

MEDICAL NEWS | PHYSICIAN'S FIRST WATCH
April 1, 2015

Acetaminophen Ineffective for Low Back Pain

之前聽腎臟科的老前輩開玩笑地說，醫院的腎臟科門診對面就是風濕科，左邊是骨科。每次看到這二科的病人領藥後一大包的帶回家，真是造就了許多胃腸科和腎臟科的病人啊！

而身為一位腎臟科醫師，我們所受到的訓練也是要減少NSAID止痛藥，因為它的腸胃道和腎臟方面副作用，是令人謹記在心。然而，我們洗腎病人因為年齡高下背痛的比例也不少，開acetaminophen真的效果不如NSAID來得好。有了這篇meta-analysis，我想不能再錯怪骨和風濕科同仁開的NSAID，而我們在遇到下背痛的患者，也許可以考慮開一下NSAID，因為

"Acetaminophen is not effective for relieving low back pain, according to a BMJ meta-analysis."

Researchers analyzed the results of 13 trials encompassing 5400 patients with either spinal pain or knee or hip osteoarthritis who were randomized to acetaminophen or placebo. In two studies on low back pain, acetaminophen did not appear to improve pain, disability, or quality of life. In the remaining studies on hip or knee osteoarthritis, acetaminophen appeared to provide a small — but not clinically significant — benefit in relieving pain and disability.

In addition, patients taking acetaminophen were nearly four times more likely than placebo recipients to have abnormal liver function test results.

醫師因為擔心患者腎或是胃腸副作用而開立acetaminophen，也不要忘了，這些人可能遭受肝功能的受損。

原文連結：

For Low-Back Pain, Acetaminophen Is No Better than Placebo http://shar.es/1gJAfk

Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials http://www.bmj.com/content/350/bmj.h1225

止痛劑(NSAID)和心臟病(MI, ACS)

MEDICAL NEWS | PHYSICIAN'S FIRST WATCH
February 25, 2015
Study Highlights Risks with NSAID Use After Myocardial Infarction

雖然這已經不能算是新聞了，NSAID在心臟病患者(MI)身上，使用上要小心。

A JAMA study raises specific concerns about the safety of nonsteroidal anti-inflammatory drugs among people who've had a recent myocardial infarction. (NSAID Use With Antithrombotic Therapy After MI http://ja.ma/1LMlVVP)

Using data from national registries, Danish researchers studied over 60,000 people with a first MI, one third of whom received a prescription for an NSAID following discharge. Overall, NSAID users had double the rate of bleeding events as nonusers. In particular, people taking standard dual antiplatelet therapy with aspirin and clopidogrel had 3.3 bleeding events per 100 person-years; the addition of an NSAID increased this risk to 7.6 events per 100 person-years. Increased bleeding risks were found even when NSAIDs were used for 3 days or fewer.

因為MI後，可能會服用ASPIRIN或是CLOPIDOGREL，再加上NSAID，更會加重出血的機會，有些人甚至會增加血栓的機會。甚至，用3天短期的NSAID也會有這樣的結果。

In addition, the rate of cardiovascular events was increased by the addition of an NSAID to other drugs.

The authors note that NSAID use in people with established heart disease remains common, despite guidelines discouraging this practice.

然而目前的醫療上，NSAID使用在一些已經確診心臟病患者身上，是很常見的（因為NSAID止痛效果還是比ACETAMINOPHEN好啊），雖然心臟醫學會是反對這樣開藥的。

Editorialists conclude that for now, "practitioners would do well to advise patients with cardiovascular disease against all NSAID use (except low-dose aspirin), especially patients with a recent acute coronary syndrome."

結論：還是請大家儘量不要在心臟病患者，特別是近期有MI(ACS)患者身上使用NSAID，這樣才能趨吉避凶啊！