Dear Alice,

In light of the situation with Vioxx, what is your feeling on Celebrex? My 90-year-old father experiences a lot of pain in his back due to many age-related issues, i.e., spinal stenosis, arthritis, etc. His doctor suggested recently that Celebrex could help him, but after hearing about Vioxx, he is reluctant to take it.

Dear Reader,

Starting a new medication can be confusing and intimidating for many people — especially when similar medications have been recalled due to the risks and complications they pose (such as Vioxx, a.k.a. rofecoxib) — so kudos to you and your father for studying up on it! Benefits and side effects of all medications depend on a number of different factors. In addition, pain relievers, even within the same family (such as Celebrex and Vioxx — which are both nonsteroidal anti-inflammatory drugs or NSAIDs), differ in the symptoms they treat best and the potential risks they pose. Therefore, it’s recommended that you and your father continue to talk with a health care provider in more detail about whether celecoxib (the generic name for Celebrex) is the best pain medication for your father. Considering your father’s reluctance, there are also alternative therapies or medications that may be more agreeable to him. More on this later. First, time to talk NSAIDs!

Before digging deeper into celecoxib, it may be worthwhile to go over the broad family that it belongs to: NSAIDs. These medications are widely used for pain relief, fever reduction, and anti-inflammatory effects, especially in people older than 65. There are a lot of different NSAIDs out there — available over-the-counter (OTC) or by prescription — each with its benefits and drawbacks. Therefore, deciding which NSAID to take depends on individual health needs and concerns, and can be done with the help and careful consideration from a health care provider. To learn more about the distinct effects of different OTC NSAIDs, read Aspirin vs. ibuprofen in the Go Ask Alice! archives.

For people with osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, or ankylosing spondylitis (a type of arthritis that affects spinal joints), celecoxib is fairly effective at relieving their symptoms, which may include swelling, inflammation, stiffness, and joint pain. It’s only available with a prescription and works in the body by preventing a specific chemical (the COX-2 enzyme) from signaling inflammation and pain, which classifies it as a COX-2 inhibitor. Compared to rofecoxib (also a COX-2 inhibitor), celecoxib is not as strong and doesn’t pose as much risk for cardiovascular issues. In addition, celecoxib is less likely to cause gastrointestinal (stomach) irritation, which is a major side effect of other NSAIDs that came before it. In fact, COX-2 inhibitors like rofecoxib and celecoxib were introduced to the market mostly in order to avoid causing this side effect.

Since their discovery, the cardiovascular risks due to taking NSAIDs have been actively researched to improve the drugs’ safety. Though celecoxib and rofecoxib may belong to the same class of drugs and work similarly in the body, they’re not the same drugs. In addition to showing that celecoxib is a weaker COX-2 inhibitor, research suggests taking a lower dose may decrease the risk of associated heart issues. However, it may not be a good choice for people who experience an increase in their blood pressure after taking it. Other people who are not candidates for celecoxib include people with pre-existing heart disease, those with hemophilia, and folks who are postmenopausal.

If your father is still not so sure about taking celecoxib, there are many other ways to help reduce back pain, some of which include:

  • Dry or moist heat at a low level of about 104 degrees Fahrenheit applied continuously on the affected area for eight hours a day. Sources of dry heat include heating lamps, heating pads, and wearable/disposable heat pads. Sources of moist heat include warm baths and washcloths soaked in warm water.
  • Cold therapy, which involves applying cold packs within the first 24 to 48 hours after pain starts in 15 to 20 minute increments. This can help reduce pain and swelling, but can damage skin if used excessively.
  • Physical therapy can strengthen back muscles and can help prevent back pain and back injuries.
  • Water exercise, especially in warm water, is a good way to stretch and strengthen back muscles while keeping the pressure from your body weight off your back.
  • Massage therapy that involves two 30-minute massages per week seems to help with reducing back pain, anxiety, and depression, improving sleep and flexibility, and increasing pain-relieving hormones.
  • Braces and corsets provide support to the hips, lower back, abdomen and can help restrict movement, allowing injuries to heal.
  • Acupuncture and acupressure can help pain without the side effects of medications, but make sure the care provider is certified and licensed.
  • Short-term use of medications such as ibuprofen (NSAID), naproxen (NSAID), acetaminophen (Tylenol), narcotics, antidepressants, muscle relaxants, and topical medications. Keep in mind that some of these may require a prescription from a health care provider.
  • Foot health-friendly shoes as uneven shoes or high heels can put stress on back and knee joints.

Adapted from Arthritis Foundation.

Last but not least, eating a balanced diet, maintaining a healthy weight, doing gentle workouts (such as yoga and tai chi), resting in moderation, reducing stress, and quitting smoking are also helpful strategies to keep the back pain at bay.

Whether your father decides to take celecoxib, try out an alternative therapy, or use both in conjunction with one another, it’s recommended that you and your father talk the decision over with a health care provider first. Hopefully, your father can find a way to lessen his pain so that he can get back to his everyday lifestyle. For even more information about rofecoxib and celecoxib, check out the U.S. Food and Drug Administration’s (FDA) Vioxx Questions and Answers and their Celebrex Patient Information Sheet.

Alice!

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