Mercy's Dr. Harrison Linder Recently Addressed Questions Regarding Proper Usage Of Ibuprofen

Harrison A. Linder, M.D., is a pain management specialist with The Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore, Maryland. Dr. Linder provides leading edge and minimally invasive treatment options for patients with disorders resulting in chronic pain. Dr. Linder recently addressed questions from Lifestyle Media Publisher, Popsugar.com, regarding proper usage of ibuprofen, a leading OTC analgesic. Here are his responses…

Ibuprofen is a nonsteroidal anti-inflammatory (NSAID). NSAIDs are frequently used for the treatment of inflammatory and painful conditions. They are considered to be one of the most commonly used class of medications worldwide. Very often, individuals involved in large amounts of physical activity, either athletes or people with physically demanding occupations, will rely on ibuprofen or other NSAIDs as a way to limit daily “aches and pains” and allow continued function. While beneficial in many ways, care must be taken to proper dosage and safe usage, as there can be serious side effects associated with overuse of these medications.

Ibuprofen and other NSAIDs achieve their effects through inhibition of an enzyme named cyclooxygenase (COX). The COX enzyme is responsible for the production of substances such as prostaglandins, prostacyclins, and thromboxanes. In most tissues, such as the GI tract, cardiovascular system, and kidneys, these substances are involved in control and maintenance of normal cellular functions. In other places in the body, such as muscles and joints, these substances are ultimately produced in response to stress and trauma, leading to inflammation and pain. Thus, in the short-term, the use of ibuprofen is beneficial due to its ability to limit the production of substances that ultimately lead inflammation and pain. Unfortunately, the effects of ibuprofen are not specific to any one tissue type, and long-term or overuse of medications like ibuprofen can lead to problems in the gastrointestinal, cardiovascular, and renal systems.

In the gastrointestinal system, prostaglandins produced by the COX enzyme are involved in protecting the lining of the stomach and intestines from the harmful effects of the stomach acids used to digest food. Without adequate prostaglandins, the gastrointestinal lining is exposed to chronic irritation from these acids. This can lead to worsening irritation and ultimately cause ulcers in the stomach and intestines. This results in symptoms ranging from abdominal pain to potentially dangerous internal bleeding.

In the cardiovascular system, end products of the COX enzyme are involved in the control of coagulation and hemostasis . Thromboxanes play a key role in platelet aggregation in response to injury and trauma. This is what ultimately leads to blood clot formation and the control of bleeding. With long-term or overuse of ibuprofen, patients may be more at risk for increased or uncontrolled bleeding.

In the renal system, prostaglandins help regulate blood flow to the kidneys. With abnormal amounts of prostaglandins, the renal blood vessels constrict leading to decreased blood flow and increased pressures. This can go on to cause acute renal failure. Furthermore, altered blood flow to the kidney can change the way the body eliminates electrolytes, leading to abnormal levels of potassium and sodium.

Essentially, ibuprofen can be of great utility for the treatment of inflammation and pain when used at safe doses and in the correct manner. The current recommendations for ibuprofen are to limit daily use to no more than 30 days. Dosing can range from 400 mg to 800 mg up to 4 times a day, with a daily maximum of 3200 mg per day. Above this limit, the negative effects of COX inhibition begin to outweigh the desired benefits of decreased discomfort and pain.

Harrison A. Linder, M.D. 

Dr. Harrison Linder addresses chronic pain issues, including back and joint pain, and chronic pain associated with cancer, orthopedic disorders and related conditions. Dr. Linder offers a particular focus on spinal cord stimulation, and its ability to reduce, if not eliminate, a patient’s reliance on chronic medications while increasing function and overall satisfaction. Together with Dr. David Maine, the center for interventional pain medicine at mercy offers dorsal root ganglion stimulation (DRG) that targets specific, hard-to-reach nerves of the spine associated with peripheral nerve pain.