A Chiro.Org Editorial ~ 9–25–2010
By Frank M. Painter, D.C.
Informed Consent involves discussing the risks and benefits of the treatment you propose (in my case, chiropractic) AND reviewing the risks and benefits of the alternatives, which are "conservative" medical care, which typically involves prescribing muscle relaxers, NSAIDs (nonsteroidal anti-inflammatory drugs), and less frequently, prescribing physical therapy.
Many patients who present to a chiropractor for the first time have already gone the medical route, with minimal or negative results. Today I would like to review the risks associated with the most commonly recommended pain relieving analgesics (NASIDs).
The newest study (Sept 2010) reporting adverse outcomes following NSAIDs use was conducted with a giant cohort...the whole population of Denmark, aged over 10 years old. This study included strictly healthy individuals, excluding anyone who was admitted to a hospital within the past five years, or those who were prescribed chronic medications for more than two years.
Previous studies by these same researchers had found increased risk of myocardial events in those who used NSAIDs, but the current study also demonstrated significant increased risk of stroke. In an interview with MedScape, the author stated: "This is very serious, as these drugs are very widely used, with many available over the counter" and also stated that "We need to get the message out to healthcare authorities that these drugs need to be regulated more carefully." 
Another recent study from Australia found increased risk of ischemic and hemorrhagic strokes in those who used NSAIDs, from as low as a 20% increase in risk to as high as a 598% increase, depending on which compound was used. 
Even more disturbing is a report written by a rheumatologist, who reviewed the health outcomes of 11,000 arthritis patients at 8 participating institutions in the United States and Canada, and then titrated those results for all those who are being treated for rheumatoid arthritis...a tiny fraction of all those who take NSAIDs for pain relief. 
The distressing findings:
107,000 patients are hospitalized annually for NSAID-related gastrointestinal complications (internal bleeding). This is a staggering 293 people every day, rushed to the hospital, with all the associated expense ($2.354 Billion dollars a year) for using NSAIDs for simple pain relief!
16,500 NSAID-related deaths occur each year among arthritis patients alone. This is a staggering 45 people DYING every day, because they used NSAIDs for simple pain relief! What a tragedy! What a crime!
The figures for all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated, and it is certainly not emphasized by the popular or medical press. As Deep Throat once advised, if you want to know why, then "Follow the Money!"
Osteoarthritis (OA) and rheumatoid arthritis (RA) patients are 2.5—5.5 times more likely to be hospitalized for NSAID-related GI events
The absolute risk for serious NSAID-related GI toxicity remains constant, and the cumulative risk increases over time with continued NSAID use
There are no reliable warning signs - More than 80% of patients with serious GI complications had no prior GI symptoms
Antacids and H2 antagonists do not prevent NSAID-induced gastric ulcers, and high-risk NSAID users who take gastro-protective drugs are more likely to have serious GI complications than patients not taking such medications
The author concluded: "Limiting NSAID use is the only way to decrease the risk of NSAID-related GI events (deaths)" 
I don't think it gets any clearer than that.
NSAIDs are killing tens of thousands of people every year!
Previous studies have also demonstrated that patients taking a 500-mg/day dose of NSAIDs had a 2.5-fold increased risk of hospitalization from complicated gastric or duodenal ulcer, while those on the 750-mg/day dose had almost a threefold increased risk of "adverse" GI complications. 
When you consider that the typical medical recommendation for neck and low back pain is to take analgesics, and then you look at the significant risks for even short-term use, and then you think about the well-documented safety of chiropractic care , one has to scratch their head after hearing that a large managed care program (Kaiser) discontinued coverage for cervical manipulation. [6, 7]
Perhaps they are cutting costs and improving Kaiser's bottom line, but they are significantly increasing the odds that their policyholders will die of stroke or internal bleeding, because they no longer have any choice but to follow their MDs recommendation to use NSAIDs for their pain relief.
If I was a Kaiser policyholder, I assure you I would be hopping mad! As it is, our role is to provide this information freely, so that Kaiser's policyholders can make a legitimate case against them, in the event they become a victim of this money-saving scheme.
(NOTE: Several months later, after a massive angry response from subscribers, Kaiser reversed their decision and reinstituted chiropractic coverage to their policy-holders)
NSAID Use Associated With Future Stroke in Healthy Population
MedScape's HEARTWIRE ~ September 8, 2010
NOTE: Rregistration is FREE
Increased risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nationwide case-crossover study
Stroke. 2010 (Sep); 41 (9): 1884-90
Recent Considerations in Nonsteroidal Anti–inflammatory Drug Gastropathy
American Journal of Medicine 1998 (Jul 27); 105 (1B): 31S–38S
Widely Used Anti-Inflammatory Drug Risky Even in Small Doses
reporting on “Naproxen use increases the risk for complicated gastroduodenal ulcers in a dose-dependent fashion”
American College of Gastroenterology (ACG) 2009; Abstract P55
The Safety of Chiropractic
A Chiro.Org Editorial
Kaiser, Chiropractic, and Chronic Neck Pain
A Chiro.Org Editorial
American Chiropractic Association responds to new Kaiser policy
excluding cervical manipulation
Return to PRESCRIPTION RIGHTS and EXPANDED PRACTICE Page