Change urged in analgesic prescriptions

The association said it based its recommendation on evidence that non-steroidal anti-inflammatory drugs, with the exception of aspirin, increase heart attack and stroke risks.

"We believe some physicians have been prescribing the new COX-2 inhibitors as the first line of treatment," said Dr. Elliott Antman, lead author of the association's statement and a professor at Harvard Medical School. "We are ... saying that, for chronic pain in patients with known heart disease or who are at risk for heart disease, these drugs should be the last line of treatment."

The AHA suggested physicians consider acetaminophen, aspirin and even short-term use of narcotic analgesics as the first step.

"If further relief is needed, physicians should suggest the least selective COX-2 inhibitors first, moving progressively toward more selective COX-2 inhibitors, which are at the bottom of the list, only if needed," the association said, noting all drugs should be used at the lowest dose necessary.

The full position statement appears in the journal Circulation.

Copyright 2007 by United Press International