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The Challenge of Treating Pain “Traditionally” when there is Heart or Kidney Disease

Many of the commonly prescribed medications used for pain need to be used with caution.

Pain is one of the most common reasons that people go to see their doctor. Developing the right treatment plan can be challenging, but this task becomes especially daunting when other medical conditions are present, including heart and kidney disease. Many of the commonly prescribed medications used for pain need to be used with caution if you have either of these conditions. Heart disease represents the number one killer in America and Congestive Heart Failure represents the most common reason that people are going to the hospital. Kidney disease affects approximately one in eight individuals, with approximately over thirty million people diagnosed with kidney disease.

One of the most common classes of medications used to treat pain include the nonsteroidal anti-inflammatory drugs or NSAIDS. The side effect profile of this class of medications makes them almost intolerable for someone with heart disease. They may antagonize the effect of aspirin and other blood thinners patients may be on which can increase their risk of developing a heart attack. NSAIDS can raise blood pressure as well. If you have kidney disease, the increase in blood pressure is detrimental to your well-being. NSAIDS also increase the risk of bleeding from the gastrointestinal tract; blood thinners such as aspirin or Plavix further increase this risk. Furthermore, NSAIDS significantly elevate your potassium levels which can affect your heart, can cause your body to retain salt and water, and have the potential to cause worsening of kidney function.

Acetaminophen is a commonly prescribed medication for pain. It is known to be toxic to the liver, but long-term chronic exposure, especially at higher doses, may affect kidney function. The use of narcotics also needs to be monitored closely in the setting of kidney disease. Morphine needs to be dosed carefully as the metabolites of morphine can “hang around” longer in the body as they are not eliminated by the kidney as quickly when kidney disease is present. This increases the potential of developing side effects including depression of the respiratory drive and increased lethargy and confusion.

The alternative is to develop a holistic treatment plan in treating chronic pain. Eating a diet that is alkaline and anti-inflammatory, promoting the use of nutrients that reduce inflammation and pain provides significant benefits to your heart and kidneys.

by Rich Snyder, DO

References

  • Kuo HW, Tsai SS et al. “Analgesic use and the risk for progression of chronic kidney disease.” Pharmacoepidemiology and Drug Safety. 2010 Jul;19(7):745-51.
  • Ray WA, Varas-Lorenzo C. “Cardiovascular risks of nonsteroidal antiinflammatory drugs in patients after hospitalization for serious coronary heart disease.” Circulation, Cardiovascular Quality and Outcomes. 2009 May;2(3):155-63.

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