Treating Of Body Pain In Peptic Ulcer Patient

One of the most common diagnose health condition by community pharmacy is body pain. Same goes for patent medicine vendors. The reason is not far fetch. The nature of jobs people do affect them a lot physically. And unfortunately, Nigerians don't bother themselves on how to minimise the side effects of the jobs they do. From white collar jobs that requiring sitting in one position for a long time to farmers bending down almost all through the day working. These postures can cause body pain over time.
Diagnosing it is not big deal. Treating it can be as simple as ABC. Different pain killers does the magic. However, the story change when the patient has history of stomach or peptic ulcer.
Read Also: Should ulcer drugs be taken before or after mesl
Peptic ulcer is a sore in the stomach. This sore causes pain to the sufferer when the acid in the stomach touch it. The two main causes are the bacteria, helicobacter pylori or Non-Steroidal anti-inflammatory drugs (NSAIDS). The type of food consume have not yet been implicated. So, too an empty stomach have not been confirmed to cause it because the acid in the stomach reduce as long as there is no food in the stomach. This shows that empty stomach does not cause ulcer but only make it worse for those with it. However, certain foods such as spicy, alcohol, caffeine, coffee, acidic foods cause acid reflux. This is a condition whereby the lower esophageal sphincter causes the lower esophagus to relax thereby allowing acid to climb back the esophagus causing heart burn, indigestion and pain. Overeating or eating within 2 hours before going to bed worsen it.

Body pain management

NSAIDS are pain killers. They belong to a group of pain killers known as non-opiods analgesic. The way they work is different from the opioid analgesic. They are the preferred drug of choice for acute pains such as body pains. But now, they have been fingered to be one of the cause of peptic ulcers. They also make it worse. Now, how can ulcer patients who have been diagnose of body pain be treated? Switch to opioid? Unfortunately, opioid are drugs that are classifieds as prescription only medicines (POM). They are use for chronic pain and not acute pains like body pain. But one could have still thought of using it for body pains in ulcer patients since it can still work? We might not have to consider that option because opioid have a very serious side effects which some may not consider as anything. It can cause dependence. For this singular reason, it is best to keep it aside. Does that mean that ulcer patients must live with the pain? Lets us see what Musa Drini has to say from his research on treating body pains with medications.
According to Musa Drini in his research work, Peptic Ulcer Disease and Non Steroids anti inflammatory drugs, published June 2017 40(3): 91-93, NSAIDS inhibit prostanoid biosynthesis. Prostanoid derivatives arise from the conversion of arachidonic acid by cyclo-oxygenase (COX) isoenzymes following cell injury. There are two distinct isoform of cox. Cox 1 is present in majority of cells in the body including endothelial cells, gastrointestinal epithelium and platelets. Cox 2 is only in few tissues that is induced by inflammation. The therapeutic effects of NSAIDS is the inducing of Cox 2. Unfortunately, majority of NSAIDS induce Cox 1 too. Only few selectively induce Cox 2. Cox 1 inhibition in the gastrointestinal tract is the cause of gastric ulcer and renal toxicities due to reduce prostanglandin secretion and it's cytopotective effects. However, Cox 2 also have some level of gastric ulcer and renal toxicities but not as much as the Cox 1. Also, all the NSAIDS inhibits Cox isoenzymes at different degree. This is where professional judgement comes into play.

What To Consider When Prescribing

Treating pains with NSAIDS can pose some problems even if the person is not an ulcer patient. This is because there are predisposing factors that can trigger it or expose the person to it. They are:

• age above 60 years
• Past medical history of peptic ulcer
• Heart disease
• Antiplatelet drugs
• Anticoagulant drugs
• Corticosteroids

Peptic ulcer

Patients who do not fall into this category have about a 0.4% possibility of developing peptic ulcer which is not bad.
The research by Musa further went on to show the level of toxicities by the different NSAIDS under clinical settings. Aceclofenac, celecoxib and ibuprofen risk of upper gastrointestinal complications is <2. Diclofenac, meloxicam and ketoprofen toxic effect are intermediate between 2-4. Naproxen, indomethacin and diflunisal have a higher relative risk of 4-5. The highest pooled risk is associated with piroxicam (7.4) and 11.5 for ketoralac.
From this result, it is clear that drugs with selective Cox 2 inhibition has lower gastrointestinal disturbance. Unfortunately, they have an associated increase risk in cardiovascular events although low those diclofenac showed no cardiovascular risk even though it is among those with high selective Cox 2 inhibitors. Low doses over a short duration should help to reduce cardiovascular events risk.

Strategies In Treating Body Pain In Ulcer Patients

Fortunately for us, the research went further to treat ulcer patients with pain killers while administering proton pump inhibitors (PPI) such as omeprazole at the regular dose in some cases. The result showed that all three methods yielded positive results. They include:

1. PPI with selective Cox 2 inhibitors having the lowest absolute event probability (0.07, 95% confidence interval 0.02-0.18)
2. Selective Cox 2 inhibitors alone
3. Non selective Cox inhibitors and PPI

For the use of H2 receptors inhibitors such as cimetidine in place of PPI, daily dose was not effective but double dose did the magic. The study went further to analyse the results with misoprostol which was also found to be effective. Unfortunately, the side effects such as spasm with this drug make it not fit for use. However, there are brands with diclofenac and misoprostol design solely for treating pain in this conditions.
Read Also: The Three Main Causes Of Stomach Ulcer
NSAID designed as enteric coated or different salts can only reduce this effects as the drug works from the blood stream. The reason is that the drug affect prostaglandin when it has been absorb into the blood stream and not at the stomach level. However, one must state clearly that most NSAID cause stomach upsets when they come in contact with the stomach lining. This is different from peptic ulcer. The different salts only increase absorption rate thereby limiting the time the drug is in contact with the stomach thereby reducing stomach upset. Injections are not better than tablets. They bypass the stomach and reduce stomach upset too. The same way too suppositories work but they are all implicated in peptic ulcer. The gastrointestinal events is same.
As for peptic ulcers cause by Helicobacter pylori, eradicating it together with the other drugs can help. According to a research publish online in 2002, In H pylori infected patients, all three active therapies with an antibiotics against the bacteria causing ulcer, there was a reduction in the occurrence of NSAID associated peptic ulcer and dyspeptic symptoms requiring therapy.
Nursing Advice: take NSAID with food and avoid smoking.