Celebrex, Vioxx, Bextra vs Opioids for Back or Neck Pain

Close up of oval white pill, Vicodin
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From anti-inflammatories, to opioids to anti-depressants and more, many types of medications are commonly prescribed for chronic back and neck pain. While most can be 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.

Cox-2 Inhibitors - Celebrex, Vioxx and Bextra

The pain relievers Vioxx, Bextra and Celebrex are what are known as Cox-2 inhibitors.

In 2004, Vioxx was pulled from the market because, as a Cox-2 inhibitor, it was linked to heart disease. One year later, Bextra was also pulled.

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 alert you to the questionable safety profile of this drug.

Physicians who prescribe Celebrex have been instructed by the FDA to give you a Medication Guide, which will cover risk and dosage information.

Opioids for Back or Neck Pain

But because of the risks, many people who need medication for their spine pain are looking for a replacement for Cox-2 inhibitors.

The use of opioids is encouraged by many medical researchers, doctors and, of course, the drug companies that make them.

The problem is, the drugs in the opioid class of pain medication are narcotics. This means they are highly addictive.

Because they are so effective at relieving pain, many believe opioids are overprescribed.

When you go to your doctor with a mild backache do you really need the strongest pain reliever on the market? Other, more conservative methods may be able to help you reduce or eliminate that pain - without the risk of becoming addicted.

Opioids are also prone to marketing campaigns that mislead. 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.

Celebrex, Vioxx, Bextra or Opioids - Think Before You Take

When you consider or are prescribed a pain medication, think about all the possible complications that could arise if you actually take it. You may be risking a heart attack or stroke, or living with an addiction to (often expensive) pain medication. By the way, Advil also comes with serious safety warnings.

Remember, quite often moving your body can significantly move you away from your backache.

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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