DURHAM, North Carolina—Mixing over-the-counter and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) may may be putting some arthritis patients at risk of complications, according to a new study in the February issue of Arthritis Care & Research.¹ Such dual use is linked to a lower quality of life.

"Future research should focus on establishing causal factors of dual NSAID use and evaluating the best methods to identify dual users, and who may be a at a higher risk for NSAID-related toxicity," report the researchers led by Stacey H. Kovac, PhD, of Durham Veteran's Affairs Medical Center and Duke University in Durham, North Carolina. "If inadequate pain management is a contributing factor, then identifying more appropriate pain management strategies that are less likely to cause adverse events is needed."

Two NSAIDs no better than one

The new research showed that patients taking 2 NSAIDs had lower scores on a health-related quality of life assessment. The study included 138 patients from a large regional managed care organization in Alabama who had filled at least 1 NSAID prescription between February 2002 and August 2002. Study participants also answered the 12-Item Short Form Health Survey. The researchers tracked OTC NSAID use via telephone surveys.

Overall, 26% of participants were dual NSAID users during the previous month. Those study participants who were dual users also scored lower on the physical component health-related quality of life scores (PCS-12), compared with nondual users (P = .05). There was no relationship seen between dual use and scores on the mental component health related quality of life scores (MCS-12), the study showed.

Do dual NSAID users have more pain or inadequate pain relief?

"It is possible that participants dually using NSAIDs in the current study had not received adequate pain relief from their first NSAID and therefore began using an additional NSAID to better control their pain," the researchers speculate. The study did not determine whether patients were receiving the optimum therapeutic dose of any NSAID.

Dual use could also be a marker for more severe pain, they hypothesize. "Adequate pain management may have the potential to reduce dual use, improve patient symptoms including physical functioning, and reduce patient safety problems," the study authors conclude.

Do ask, do tell

The authors point out that many patients may not tell their doctors about the OTC NSAIDs they are taking.

"This analysis strongly emphasizes the need for individuals who take medicine on a regular basis—either prescription or over the counter—for pain or inflammatory conditions to inform their clinicians what medicines they are taking," said A. Mark Fendrick, MD, professor of internal medicine and health management and policy at the University of Michigan in Ann Arbor. "It is well known that the risk of serious side effects of these medications increases substantially with both the dose and number of medicines you take."

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