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Some painkillers may do more harm than good: study

foil tray of painkillers

You might not be familiar with the term ‘non-steroidal anti-inflammatory drugs’ (NSAIDs), but the chances are you use them quite regularly. The phrase is used in the medical profession to describe common painkillers such as aspirin and ibuprofen.

These painkillers are generally regarded as a great way to temporarily relieve pain, with few or no side-effects for most. And generally speaking, that’s true. But a new study shows that those tablets and capsules can cause serious health problems.

The results of the study conducted by Anna Eisenstein, from the department of dermatology at Yale School of Medicine, and several colleagues, have been published in the online journal Immunity.

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Dr Eisenstein and her co-authors uncovered a previously unknown process by which some NSAIDs affect the body. The finding may explain why similar NSAIDs produce a range of outcomes and could inform how the drugs are used in the future.

They found that, even at similar doses, different NSAIDs can have unexpected and unexplained effects on many diseases, including heart disease and cancer.

It has long been thought that the anti-inflammatory effects of NSAIDs arose solely through the inhibition of certain enzymes. In fact, some NSAIDs – including indomethacin (used to treat arthritis and gout) and ibuprofen – also activate a protein called nuclear factor erythroid 2-related factor 2 (NRF2). Among a number of other actions, NRF2 triggers anti-inflammatory processes in the body.

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For Dr Eisenstein and her colleagues, this came as a surprise. “It’s interesting and exciting that NSAIDs have a different mode of action than what was known previously,” she said. “And because people use NSAIDs so frequently, it’s important we know what they’re doing in the body.”

So what are the implications of these findings?

The first thing to note is that the research to date has been conducted on cell cultures and mice, and human trials will be required. The researchers are not yet sure that NSAIDs’ unexpected effects are due to NRF2, but Dr Eisenstein said: “I think these findings are suggestive of that.”

Human trials could have an impact on how inflammation is treated and how NSAIDs are used. For instance, several clinical trials are evaluating whether NRF2-activating drugs are effective in treating inflammatory diseases such as Alzheimer’s disease, asthma and various cancers.

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Such research could reveal the advantages and limitations of those drugs. Ultimately the research could help ensure that NSAIDs are more effectively prescribed. This would result in NRF2-activating NSAIDs and non-NRF2-activating NSAIDs and applied to the diseases they’re most likely to treat.

It’s known that some NSAIDs prevent heart disease while others cause it, and Dr Eisenstein is now looking into some of the drugs’ dermatological effects, causing rashes, exacerbating hives, and worsening allergies – and whether they are due to NRF2.

There is nothing in the research that suggests you should rush to the medicine cabinet and discard all your unused Nurofen and Disprin tablets, but it serves as a reminder to treat these medications with respect.

Follow the dosage instructions and the advice most over-50s would remember hearing at the end of medical ads on TV: “If symptoms persist, see your family doctor.”

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