Drugs formerly contraindicated for inflammatory bowel disease prove beneficial for pain relief

According to two studies published in the American Gastroenterological Association (AGA) journal Clinical Gastroenterology and Hepatology, prescription painkillers are effective in easing the pain of patients with dormant inflammatory bowel disease (IBD) and are not likely to cause symptom flare-ups in IBD patients in remissions.

Both studies examined the benefits of non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors, in a patient population with ulcerative colitis and/or Crohn's disease. Study findings show that NSAIDs were well-tolerated, with COX-2 inhibitors offering the most effective pain relief in this group.

"In the past, physicians have considered ulcerative colitis and Crohn's disease as contraindications for prescribing NSAIDs. These studies represent an important advance for patients with inflammatory bowel disease and their gastroenterologists searching for safe medications to help with pain relief," said Joshua R. Korzenik, MD, author of an accompanying editorial from Massachusetts General Hospital in Boston. "Patients with ulcerative colitis and Crohn's disease can now use COX-2 inhibitors for brief periods of time to relieve pain with the assurance that they are not risking a flare-up of their disease symptoms."

Patients with IBD often need anti-inflammatory painkillers for peripheral arthritis, back pain, fractures and osteoarthritis. However, some researchers have argued that these painkillers have negative effects on IBD patients in remission. According to a study in this month's issue of Clinical Gastroenterology and Hepatology, patients with IBD who use NSAIDs tolerate the drugs well and less than one in three patients experiences a flare-up in symptoms. Furthermore, the study shows COX-2 inhibitors, previously thought to cause symptom recurrence in IBD patients, significantly reduce the likelihood of disease relapse.

To date, this is the most comprehensive study to address the effects of NSAIDs on disease activity in patients with IBD.

"Our findings suggest that patients with 'silent' inflammatory bowel disease requiring anti-inflammatory drugs tolerate NSAIDs very well, despite the minimal risk for disease relapse," said Ingvar Bjarnason, MD, study author. "If a patient with IBD requires an NSAID for pain relief then these drugs should not be withheld on the belief that they will cause worsening of disease symptoms."

Researchers from Guy's, Kings and St. Thomas' Medical School in London conducted a study that involved 209 patients with inflammatory bowel disease (ulcerative colitis and Crohn's disease) between the ages of 20 and 70 years old who were in full clinical remission for six weeks prior to the start of the study. Patients were given several painkillers, including acetaminophen, naproxen and a COX-2 inhibitor nimesulide for four weeks to determine rate of relapse. This study shows that NSAIDs cause clinical relapse within a few days of ingestion in only 17 to 28 percent of asymptomatic patients with IBD while drugs that were selective for COX-1 and COX-2 were not associated with relapse.

Another study published in this month's Clinical Gastroenterology and Hepatology addresses the gastrointestinal safety of COX-2 inhibitors in providing pain relief without relapse in IBD patients in remission. Therapy with celecoxib (Celebrex), a COX-2 inhibitor, for up to 14 days did not have a greater relapse rate than placebo in patients with ulcerative colitis in remission with a history of arthritis, arthralgia or other conditions causing them to need pain relievers.

"Previous uncontrolled pilot studies have shown a potential association between COX-2 inhibitors and clinical relapse in patients with ulcerative colitis," said William J. Sandborn, MD, lead study author. "However, the findings of our placebo-controlled study represent the first concrete evidence that short-term therapy with celecoxib does not lead to increased disease relapse in these patients. Additional studies should be conducted in other inflammatory bowel disease patient populations to determine if this class of drugs would be equally as beneficial to the patients."