Craig Pittar wrote:
> I read in the paper recently(N.Z.), about new forms of pain relief being
> approved by the Federal Drug Agency.
> Cox 2 type, that are reported to have far less side affects.
>
> The question to the list is,
>
> How will this potentially effect practitioners in the musculoskeletal
> field, Spinal Pain, Joint Pain etc.
> My impression is that the driving force for people to consult a
> practitioner, is due the pain, or what the pain may mean to the person.
>
> Sometimes patients have seen me complaining of only lack of function,
> strength etc. I.E. I cant walk on my tip toes.
> With a ruptured archilles tendon on assessment.
> "Had it for four weeks, hurt when I did it, but the pain went away
> quickly, so I haven't bothered to get it looked at".
>
> A patient I saw actually had it for 4 years before having someone look
> at it ( this is not a representation of a normal New Zealander).
>
> The question is, How great is the threat of substitution of product?
> Cox 2 substituted for Physical Therapy.
>
> There are probably a great deal of reasons to attend Physiotherapy, from
> a clinical academic point of view.
>
> But for the man on the street, if his major motivating reason for
> seeking secondary care (physiotherapy), which in this case may be pain,
> is removed or greatly diminished, will we then see far fewer people
> coming through our doors looking for help?
>
> I am interested in you're views
>
> Kind Regards
>
> Craig
Dear Craig,Do not worry. COX-2 inhibitors are the new generation of
non-steroidal anti-inflammatory drugs, and therefore pose no greater threat
to our practice than any other NSAIDs. (I may have a little inside knowledge
here, having been involved in drugs trials of a COX-2 inhibitor, meloxicam,
in ankylosing spondylitis.)
NSAIDs work by suppressing the production of prostaglandins, which are
involved in the production of pain and inflammation. The enzyme
cyclooxygenase (COX) is important in prostaglandin production, and NSAIDs
work by inhibiting COX.
Recently different forms of COX have been found - COX-1 and COX-2.
COX-1 has a “housekeeping” role, helping to maintain the integrity of
gastric and duodenal mucosa, regulating renal blood flow and helping with
salt and water balance.
COX-2 is the "baddie" associated with inflammation.
The problem with most NSAIDs is that they knock out both COX-1 and COX-2,
hence side-effects such as gastric ulceration. If you can develop drugs
which selectively target COX-2, you can in theory reduce pain and
inflammation without causing the serious side effects (this is a BIG topic
in rheumatology.)
The bottom line is - COX-2 inhibitors aren't wonder drugs. From my
(admittedly limited) experience, they seem to have fewer side effects but
are not maybe as effective as some of the older ones. (It was a big trial -
anyone else out there involved in it who wants to comment?) I don't think
our profession is in danger. I totally agree with both Nicky and Erik's
remarks that drugs are only tools - nothing's that good that it will cure
all the woes of the world.
Regards,
Carol David
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