Vioxx Settlement Puts Painkillers Back in the Spotlight

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In fact, these complications have risen 21 percent, said a group led by Dr. Gurkirpal Singh, a rheumatologist and a clinical professor of medicine at Stanford University School of Medicine.

Again, when it comes to stomach risks, the decision as to whether to prescribe Celebrex should be made on a case-by-case basis, one expert said.

"There is a lot of confusion over the cox-2 inhibitor Celebrex and the traditional NSAIDs as well," said Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan School of Medicine and professor of health management and policy at the University of Michigan School of Public Health.

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For arthritis patients, Fendrick starts treatment with exercise and physical therapy. "I try hard to avoid all drugs and then use topical medications and acetaminophen as first-line medications," he said.

But for patients who need other medication, Fendrick bases his advice on a combination of the individual patient's risk factors for heart disease versus their risk for gastrointestinal problems. "I recommend cox-2 inhibitors like Celebrex for patients who are at risk of gastrointestinal side effects but at low risk for heart disease," he said.

Celebrex has never been shown to be a superior pain reliever and anti-inflammatory drug over any of the other NSAIDs, Fendrick said. "So, alternatives for pain relief and anti-inflammatory effect are just about as good as traditional NSAIDs," he said.

For people who have a high risk of gastrointestinal side effects, such as those with a history of gastrointestinal problems and those taking anticoagulant drugs, Fendrick recommends coupling NSAIDs with stomach-soothing drugs called proton pump inhibitors. These drugs include widely used medications such as Nexium, Prevacid and Prilosec.

More information

There's more on pain relievers at the U.S. National Library of Medicine.

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