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Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: A population-based follow-up study British Medical Journal Open April 8, 2014; Vol. 4; No. 4;

Non-steroidal anti-inflammatory drugs and the risk of atrial fibrillation: A population-based follow-up study British Medical Journal Open April 8, 2014; Vol. 4; No. 4;

 

From the Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

1) Atrial fibrillation (AF) is a common cardiac arrhythmia, which is associated with increased morbidities (stroke and heart failure), increased mortality and reduced life expectancy.

2) “Several drugs have been associated with an increased risk of AF including nonsteroidal anti-inflammatory drugs.” [NSAIDs]

3) NSAIDs are inhibitors of cyclooxygenase, and are widely used to treat inflammatory conditions and pain. [They block the conversion of the omega-6 fatty acid arachidonic acid into the inflammatory eicosanoid prostaglandin-E2 (PGE2)].

4) Use of NSAIDs is associated with a higher risk of myocardial infarction, stroke and heart failure.

5) The objective of this study was to investigate the association of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of atrial fibrillation in a prospective community based population. The study involved 8,423 participants without atrial fibrillation at baseline. The mean baseline age of the study population was 68.5 years. Follow-up averaged 12.9 years.

6) Current use of NSAIDs increased the risk of atrial fibrillation by 76% compared with never-use.

7) Recent use (within 30 days after discontinuation of NSAIDs) was associated with an increased risk of atrial fibrillation by 84% compared with never-use.

8) “In this study, use of NSAIDs was associated with an increased risk of atrial fibrillation.”

9) Higher dosages of NSAIDs appeared to be associated with a higher risk of atrial fibrillation.

10) “Our results suggest that NSAID use is associated with a higher risk of AF. Current use and recent past use were associated with a higher risk of AF, adjusted for age, sex and cardiovascular risk factors.”

11) The risk of AF was strongest for COX-2 inhibitors. [Celebrex] 1

12) NSAIDs damage the kidneys, increasing blood pressure and thus increasing risk of AF.

13) “In conclusion, we found that use of NSAIDs is associated with an increased risk of AF. Current use and recent past use were especially associated with a higher risk of AF, adjusted for age, sex and cardiovascular risk factors.”

 

COMMENTS FROM DAN MURPHY: Over the years we have reviewed a number of studies showing adverse effects to NSAID pain medications, including these:

KIDNEY DAMAGE Article Review #50-10 Risk of Kidney Failure Associated with the Use of Acetaminophen, Aspirin, and Nonsteroidal Antiinflammatory Drugs New England Journal of Medicine, December 22, 1994 GASTROINTESTINAL BLEEDING Article Review #33-1999

GASTROINTESTINAL TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS The New England Journal of Medicine, June 17, 1999 Article Review #21-06 Omega-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti- inflammatory drugs for discogenic pain Surgical Neurology, April 2006

HEART ATTACK / STROKE Article #30-06 NSAID use and the risk of hospitalization for first myocardial infarction in the general population European Heart Journal, May 26, 2006 Article Review #13-12 Cardiovascular safety of non-steroidal anti-inflammatory drugs British Medical Journal, January 11, 2011 Article Review #33-12 Duration of Treatment With Nonsteroidal Anti-Inflammatory Drugs and Impact on Risk of Death and Recurrent Myocardial Infarction in Patients With Prior Myocardial Infarction Circulation; May 21, 2011

DEMENTIA / ALZHEIMER’S Article Review #29-10 Risk of dementia and AD with prior exposure to NSAIDs Neurology, April 22, 2009

HEARING LOSS Article Review #5-12 Analgesic Use and the Risk of Hearing Loss in Men The American Journal of Medicine; March 2010

ERECTILE DYSFUNCTION Article Review #17-12 Regular Nonsteroidal Anti-Inflammatory Drug Use and Erectile Dysfunction Journal of Urology; April 2011 2

 

Submitted by

Gregg F. Moses DC

1800 Forest Hill Blvd

Ste A 8 – A 10

West Palm Beach, FL 33406

561.641.9211

moseschiropractic.com

Spinal Manipulation (chiropractic care) compared to back school and physiotherapy for chronic low back pain

Well a belated Happy New Year to all.  A beautiful day here in S. Florida (specifically West Palm Beach)…about 50 degrees this morning.  A little cold for some, but sure is better than the 20 inches or so they had this weekend across the mid-Atlantic states.  Over the past few weeks I watched my NY Jets over-achieve and make it to the AFC Championship game.  This season concluded yesterday as the NO Saints beat the Colts in a great game.  I was away in Naples, FL two weeks ago.  Dr. James Cox was there speaking on the latest regarding the treatment of neck and back pain with the Cox Technique.  He focused on FBSS, Failed Back Surgical Syndrome.  I want to share a recently published article from Clinical Rehabilitation 24  (1). Jan 2010 p.26-36.  The authors are Cecchi, F; Molina-Lova, R; Chiti, M; Pasquini, G; Conti, AA; Macchi, C.  The title is “Spinal Manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic lower back pain: a randomized trial with one-year follow-up”.

I only have the abstract for this study and I will give some details. 

Objective:  To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain.

Design:  Randomized trial with 12-month follow-up.

Setting:  Outpatient rehabilitation department.

Participants:  210 patients with chronic, non-specific low back pain, 140/210 women, age 59 +/- 14 years.

Conclusions:  Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.

As a chiropractor I am certainly not surprised that spinal manipulation gave more pain relief, but overall back school and physiotherapy are wonderful adjuncts to chiropractic in the treatment of our patients.  I have read many medical journal since my last blog and have a lot of articles to share.  I hope to do an entry about once a week.  Should anyone have a specific topic they would like more information on, just send me an e-mail and ask.

Gregg F Moses, DC

Cox Decompression Treatment for the Pregnant Patient with Lower Back and Leg Pain

Thanks again for viewing this blog.  I had a great week in the office.  In addition to chiropractic care, we also have full physical therapy and massage therapy.  Pregnant patients with lower back pain are always interesting and sometimes difficult to treat.  Certainly if the patient has leg pain, more caution should be given with the treatment.  We are somewhat limited as to what treatment can be done.  Although many chiropractors do traditional / diversified manipulation for pregnant patients with lower back pain, I choose to do the Cox Decompression Technique.

 

This article / case study was published in Journal Of Chiropractic Medicine , December 2007 and authored by Ralph A. Kruse, DC, Sharina Gudavalli, DC and Jerrilyn Cambron, DC, MPH, PhD.  I have included the abstract.

Abstract

Objective

The purpose of this report is to describe chiropractic treatment of lower back and unilateral leg pain in a pregnant patient.

Clinical Features

A 26-year-old woman in her second trimester of pregnancy had severe pain in her lower back that radiated to her hips bilaterally and to her right leg. She reported tingling down her right lower leg to the dorsum of her foot. Although no diagnostic imaging was performed, her differential diagnoses included lumbalgia with associated radiculopathy.

Intervention and Outcome

Treatment consisted of manual traction in the side-lying position using a specialized chiropractic table and treatment technique (Cox flexion-distraction decompression) modified for pregnancy. Relief was noted after the first treatment, and complete resolution of her subjective and objective findings occurred after 8 visits.

Conclusion

When modified, this chiropractic technique appears to be an effective method for treating lower back pain with radiation to the leg in a pregnant patient who cannot lie prone.

I hope this article / case study was helpful.  Feel free to contact me by clicking the following link: chiropractor west palm beach.  You can also find a certified Cox Technique practitioner on Dr. Cox’s website www.coxtechnic.com.

Respectfully submitted,

Gregg F Moses DC