informed consent using NSAIDs for arthritis pain

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informed consent using NSAIDs for arthritis pain

Postby malernee » Tue Sep 07, 2004 4:29 pm

First let me say it can be difficult for us to know when treating osteoarthritis if NSAID's drugs are causing more harm than good.

Warning Concerning NSAIDs Arthritis Medications
All Non Steroid Anti-inflammatory Drugs Can Kill

Rimadyl, Etogesic, Dermaxx, Metacam and Zubrin all belong to a class of drugs called non-steroid anti-inflammatory Drugs. The action of these drugs is similar to aspirin, in that they inhibit inflammatory substances called prostaglandins (PGEs), which cause pain, inflammation, and fever. These drugs can be safer than aspirin for some patients but not all patients because they are more selective for the harmful prostaglandins, COX 2 PGEs, and spare certain prostaglandins, COX 1 PGEs, which are essential to protect the G.I. tract, kidneys and other organs.
(This may be an over-simplification)

There is risk of liver failure with all NSAIDs. Liver necrosis in Labrador Retrievers caused by Rimadyl have been reported in the largest numbers. The manufacturer of Rimadyl alleges these reactions are attributed to the facts that Labs are the most common Breed, and Rimadyl was the first and most commonly prescribed NSAID. Rimadyl may be getting a bad rap but its hard to tell right now. Until more information is available, I prefers to exercise caution, and not to use this drug on most arthritic patients. All NSAIDs have the potential to cause liver failure. Blood tests before administration of NSAIDs cannot predict this liver reaction. The risk of this reaction reported is small. (1:10,000 with Rimadyl)

(This may be an over-simplification) since most cases of harmfull reactions are not reported. Or at least not before the sucessful lawsuit cases.

NSAIDs are relatively new to Veterinary Medicine. Veterinarians have little clinical experience with these drugs. Although every manufacturer has data that alleges their drug is safer than the others, No credible non-manufacturer sponsored data exists which accurately compares these drugs.

I dont like Client attorneys calling me any better than any other doctor. I do think however the system is boken. We have 7 new NSAIDs on the market and many DVMs dispense them without even reading the flyers much less getting some CE first. CE credit is allowed by speakers who are paid employees of drug companies. This is a hughe conflict of interest. They do not tell you how to avoid side effects. They do not even aknowledge that there are side effects. They adamantly denie them. Dr DeBakey the heart surgeon addressed this issue in a recent letter to the editor of the Houston Chronicle. He said "Optimum patient care depends on treatment choices based on peer reviewed scientific evidence, not the best sales pitch." The State Boards do not address issues in such a way as DVMs can learn from others mistakes. In a malpractice law suit against a DVM the maximum you can get in some states is $500. You cannot even get an attorney to do much more than talk to you for that amount. From the consumers stand point there is no way to encourage or insure a high standard of care. A class action law suit is their last resort. Dogs and cats are considered cheap property by the state courts. ... ?p=367#367
for more information about using these drugs see ... ?p=727#727
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