PXE AND PAIN

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By: Kenneth H. Neldner, M.D.

PXE in general is not a painful disorder. The closest pain that would be PXE related can occur in those who have intermittent claudication. That’s the big unwieldy name for aching (and possibly pain) in the legs that comes after jogging or fast walking. It occurs in about 30% to 50% of those past age 30 to 40 years and does gradually become more common with age. It is caused by narrowing of the arteries in the legs due to calcium deposits. This discomfort disappears within a minute or two after walking is stopped, but then reappears if the same pace is resumed.

I get frequent phone calls, letters and emails from PXE patients asking if the arthritic pains in their backs, knees, necks, etc. are related to PXE. The answer is almost always “No.” About 50% or more of the general population get mild or moderate to severe arthritic aches and pains in various joints as a consequence of aging and the lack of exercise. So the likelihood of someone with PXE getting arthritic type pain unrelated to PXE can be quite high.

On the other hand, pain is pain – no matter what the cause. So back to the questions, “what is the best analgesic pain pill for someone with PXE?”

Many of you are well aware that most of the standard non-prescription pain pills have the potential to irritate the stomach, and also are anticoagulants (blood thinners), which could have adverse effects in PXE for someone at increased risk for stomach or retinal bleeding. We have, therefore, recommended that you avoid aspirin and the so-called non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen, Motrin, Advil and Naproxen.

Because Tylenol (acetaminophen) is easier on the stomach and has no blood thinning properties, it can be taken more safely; however, in my opinion, it has relatively poor pain relieving properties. If large doses are taken for long periods of time, it can be toxic to the liver, so a liver function blood test should be obtained every 3 or 4 months by anyone taking Tylenol regularly.

Now for the good news! The latest in a long series of NSAIDs to be developed has very little anticoagulant effect and has quite good pain relief. Its chemical name is Celecoxib and its trade name is Celebrex (Searle). Studies also have shown that Celebrex has relatively little stomach irritation compared to the other NSAIDs, which is another big plus for anyone with PXE.

The only bad news is that, as with any new drug, it is still more expensive than the older NSAIDs. But, if it helps anyone with PXE who also has arthritic joint pains, it should be safe to take and may be worth the added expense. Celebrex requires a prescription. It comes in 100mg doses for morning and evening. Larger doses can be taken for severe pain. If you are also taking other medications, be sure to check with your doctor about any possible adverse drug interactions. As with any medication – if it doesn’t agree with you – you should stop it.

By: Kenneth H. Neldner, M.D. 8:4 (Winter 2000)