Q: I have severe arthritis in my right hip. I have an appointment with an orthopedic surgeon in November. It will probably take even longer before I can have hip surgery. Meanwhile, I take six ibuprofen 200 mg to tolerate the pain. My problem is that I have elevated kidneys. Is there something I can do for this, like changing pain medication?
A: Individuals who take ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) other than aspirin may have an increased risk of stroke or heart attack over those that do not take the medication – even though ibuprofen is an over-the-counter pain reliever. NSAIDs may, and I stress may because there is a possibility and not a probability, also cause a bleed, ulcers, or holes in the intestine or stomach. While symptoms can occur without warning, if an individual should experience any unusual symptoms such as heartburn, pass stools that are tarry or bloody, have abdominal pain or should vomit a bloody substance that resembles coffee grounds, he or she should discontinue the ibuprofen and advise a health care provider immediately. If the orthopedic surgeon cannot be reached, he or she should be sure to touch base with the primary care physician who should be made aware of and monitor the symptoms.
Ibuprofen is primarily used for mild-to-moderate pain following surgery, for fever, diseases and disorders such as osteoarthritis, migraine headaches, and countless other issues. In fact, ibuprofen is on the World Health Organization’s list of essential medicines as the most important medication needed in a basic health system. However, its prolonged excessive use is what should be avoided. The usual reported adult dose of ibuprofen for control of osteoarthritis and rheumatoid arthritis begins at between 400 and 800 mg orally every six to eight hours, followed by a maintenance dose of 3200 mg daily based on a patient’s response and tolerance. Keep in mind, however, that a physician-recommended OTC use for management is 1200 mg per day, unless the patient is under a doctor’s care when dosing for severe arthritis may be as high as 3200 mg per day; If renal disease is involved (as is the case with you), the maximum dose is appreciably less and must be carefully monitored.
Common adverse effects of ibuprofen include rash, hypertension, nausea, dyspepsia, the gastrointestinal ulcers/bleed mentioned above, diarrhea, and elevated liver enzymes. Less frequently, unwanted effects may include hyperkalemia and renal impairment, most commonly kidney cancer. The severity of symptoms varies based on the dose ingested and the time lapse between doses, yet each individual responds differently, making individual sensitivity extremely important. As a general rule, symptoms observed with an overdose are similar to those caused by an overdose of other NSAIDs.
As an option, you might consider analgesics such as Tylenol that will fight the pain you experience but won’t control inflammation. Analgesics may be over-the-counter or absorbed through the skin through a transdermal patch. Tylenol is recommended by the American College of Rheumatology as a first-line treatment for osteoarthritis pain.
Then there are corticosteroids that help regulate the immune system fight the inflammation that causes pain. Corticosteroids can be taken orally, as transdermal patches, or injected directly into specific areas of the body.
Lastly and not a favorite recommendation are opioids that are ideally taken short-term only, since they . carry serious side effects including dependence and constipation. However, slow-acting patches may be good for the pain of arthritis according to some physicians because the medication is delivered in small doses.
You don’t state who recommended you take the ibuprofen for pain control. If it was a physician, you should make an appointment and provide an update. Ask if another medication via prescription or an over-the-counter might be more appropriate until you can get to the orthopedic surgeon in November. I also cannot determine if you have already seen a surgeon who has indicated you require surgery for pain relief or if this is something you have taken for granted. If the latter is the case, there may be other possibilities to consider. Weigh all your options before making the decision to have a surgical procedure done.
