HEALTHPost-COX-2, pain relief strategies present new challengesHeart protection has become more important than safeguarding the GI tract, but this, in turn, can make regimens more difficult and more expensive.By Victoria Stagg Elliott, amednews staff. June 6, 2005. When physicians make choices about how to treat pain, preventing gastrointestinal bleeding is no longer a priority on the list of factors they consider. Protecting the heart is, according to an expert panel at Digestive Disease Week held in Chicago last month. This event is an annual joint meeting of the American Assn. for the Study of Liver Diseases, the American Gastroenterological Assn., the American Society of Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract. "When physicians are selecting an NSAID [consults with gastroenterologists] are not as important because it's not about protecting the GI any more," said James Scheiman, MD, a gastroenterologist and director of the Endoscopic Ultrasound Program at the University of Michigan Medical School, Ann Arbor. "In 2005, the heart has got to come first." This mind-set is the result of the controversy over the use of COX-2 inhibitors. Since both Vioxx (rofecoxib) and Bextra (valdecoxib) have been withdrawn from the market and stronger warnings have been placed on Celebrex (celecoxib) -- all because of increased cardiovascular risks associated with long-term use -- physicians and patients are returning to the older nonsteroidal anti-inflammatory drugs. "We're seeing less and less use of COX-2s except for highly selected patients," said Dr. Scheiman. Guidelines are soon expected to start reflecting this change. For the moment, though, experts are wrestling with how to ensure the greatest pain relief while providing the fewest risks. [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2005 American Medical Association. All rights reserved.
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