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Life without COX 2 inhibitors

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7553.1287 (Published 01 June 2006) Cite this as: BMJ 2006;332:1287

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Life without COX 2 inhibitors has problems.

The theme of this Editorial is that COX 2 inhibitors are not a
superior option for the management of musculoskeletal pain, and that
paracetamol can be equally effective and much safer. From personal
experience I suggest that for some of us, COX 2 inhibitors provide
significantly better pain relief than can be secured by conventional
NSAIDs or by paracetamol.

As a result of sports activity I suffer from bilateral shoulder pain
of variable severity. It was partially alleviated by ibuprofen in a dose
of 800 mg four times a day. I never suffered gastrointestinal side effects
from ibuprofen, but when it was demonstrated that the drug could nullify
the cardioprotective effects of low-dose aspirin, I switched to rofecoxib,
then thought to be a safe drug. I took two tiny tablets of 12.5 mg each,
once a day. This more convenient medication produced complete pain relief.
Furthermore, the onset of action was in approximately 30 minutes. Thus on
three counts - convenience, pain relief and immediacy of action -
rofecoxib was definitely superior to ibuprofen.

Then came alarming reports (1) that rofecoxib in particular, and
perhaps COX 2 inhibitors in general, were associated with an increased
risk of myocardial infarction, so I switched to paracetamol. I am now
constrained to take two 500 mg tablets four times a day and the control of
pain is incomplete. I conclude that rofecoxib is a highly effective drug.
Oh for a COX 2 inhibitor that does not promote myocardial infarction!

1 Kearney PM, Baigent C, Godwin J, Emberson JR, Patrono C. Do coxibs
and traditional non-steroidal anti-inflammatory drugs increase the risk of
atherothrombosis? Meta-analysis of randomised trials. BMJ 2006;332:1302-5.

Competing interests:
None declared

Competing interests: No competing interests

03 June 2006
Alexander SD Spiers
Professor of Medicine (Retired)
n/a