Cox-2 Inhibitors Compared with Opioids

There are several types of medications commonly prescribed for chronic back and neck pain. In addition to being effective tools for pain management, each can have unpleasant, and possibly dangerous, side effects. This article compares two of them -- Cox-2 inhibitors and opioids.

Current Status

The pain relievers Vioxx, Bextra and Celebrex are what are known as Cox-2 inhibitors. In 2004, Vioxx was pulled from the market because it was linked to heart disease.

One year later, Bextra was also pulled.

Many people who suffer from chronic pain are looking for a replacement for Vioxx and Bextra. Celebrex, the only drug of the three remaining on the U.S. market, now comes with a "black box warning". This is a label designed to stand out enough to let you know that the safety of this drug is questionable. Physicians who prescribe Celebrex have been instructed by the FDA to give you a Medication Guide, which will cover risk and dosage information.

The use of opioids is encouraged by many medical researchers, doctors and, of course, the drug companies that make them. However, opioids are narcotics, and are therefore highly addictive. One brand of opioid, OxyContin, was touted as a "safe" narcotic by company representatives in a very successful marketing campaign. But the top executives of Purdue Pharma, makers of OxyContin, later admitted in court that those claims were false and misleading.

What's at Stake?

The lives, well-being and health of patients are at stake when determining what types of pain medications to take.

Vioxx and Cox-2 Inhibitors

Cox-2 inhibitors like Vioxx, Celebrex and Bextra are a type of NSAID, or non-steroidal anti-inflammatory drugs. They were developed in the 1990s in response to the side effects of NSAIDS.

Because they are in the same family of medication, all Cox-2 inhibitors behave in pretty much the same way. Therefore, patients who replace Vioxx or Bextra with Celebrex may still be at risk for heart attacks.

Although they are not Cox-2 inhibitors, other NSAIDs that pose potential dangers are Motrin, Naprosyn, Voltaren and Mobic.


Opioids are used for moderate to severe pain. In addition to chronic back pain, opioids are also administered in cases of cancer pain, nerve pain and other conditions.

Opioids are very strong pain relievers; morphine is the best known example of opioids, although there are actually several types ranging from mild-acting to very strong. Examples include OxyContin, codeine, Darvon and Vicodin.

Opioids have several side effects, including the possibility of:

  • respiratory depression
  • constipation
  • risk of dependancy and addiction

The most obvious disadvantage of opioids as pain medication is the potential for addiction and dependency. Research indicates that OxyContin, in particular, is a "gateway" to addiction to other hard drugs. Sometimes, patients may be denied the medication because their motivations are misunderstood, and they may be seen as potential morphine (or other opioid) addicts.


When properly administered, the benefits of taking opioids for pain are stronger than the associated risks. Opioids are quite effective for pain relief. And many researchers, governing bodies in medicine, and doctors feel that opioids are worth considering for the treatment of chronic pain. But as with any health care choice, work with your doctor and other healthcare professionals to find the best option for you.

Questions and Answers.FDA Regulatory Actions for the COX-2 Selective and Non-Selective Non-Steroidal Anti-inflammatory drugs (NSAIDs). FDA. April 7, 2005.
Brasseur, L. Review of current pharmacologic treatment of pain. Drugs. 1997.
Cicero, T.J., Inciardi, J.A., Munoz, A. Trends in abuse of Oxycontin and other opioid analgesics in the United States 2002-2004 JPain Oct. 2005.
Grau, L.E., Dasgupta, N., Harvey, A.P., Irwin, K., Givens, A., Kinzley, M.L., Heimer, R.. Illicit use of opioids: is OxyContin a "gateway" drug? AmJ Addict May-June 2007.

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