Are there contraindications to taking analgesics in patients with diverticular disease?

From the Guidelines

There are generally no absolute contraindications to taking most analgesics when you have diverticular disease, but nonsteroidal anti-inflammatory drugs (NSAIDs) should be used with caution due to a potential increased risk of complications. When considering pain management for diverticular disease, it's essential to weigh the benefits and risks of different analgesics.

• Acetaminophen (Tylenol) is generally safe for pain relief without significant concerns, as it does not have the same gastrointestinal risks as NSAIDs 1.
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve) can be used, but with caution, especially in patients with a history of diverticulitis, as they may increase the risk of complications such as bleeding or perforation due to their effects on the gastrointestinal lining and blood clotting 1. Key points to consider include:
• The risk of diverticulitis is influenced by various factors including diet, lifestyle, medications, and genetics, with approximately 50% of the risk attributable to genetic factors 1.
• Regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) increases the risk of diverticulitis, with a greater risk for non-aspirin NSAIDs than for aspirin 1.
• For occasional use, standard over-the-counter doses of NSAIDs are typically acceptable, but it's crucial to follow the recommended dosage and not exceed the maximum daily limit without medical advice.
• If you require regular pain management for chronic conditions while having diverticular disease, discussing your options with a healthcare provider is recommended to determine the safest choice for your specific situation, which may include acetaminophen as a first choice or combining medications at lower doses to minimize risks while providing adequate pain relief 1.

From the Research

Contraindications to Taking Analgesics with Diverticular Disease

• There are several studies that suggest a link between the use of analgesics, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), and an increased risk of complications from diverticular disease 2, 3, 4, 5, 6.
• The use of NSAIDs has been associated with an increased risk of diverticulitis and diverticular bleeding 3, 4, 6.
• Acetaminophen has also been linked to an increased risk of symptomatic diverticular disease, particularly bleeding 2.
• Aspirin, even at low doses, has been shown to increase the risk of diverticulitis and diverticular bleeding 3, 4.
• Other analgesics, such as opioid analgesics, have also been associated with an increased risk of perforated colonic diverticular disease 5.
• The risk of bleeding may be higher with certain types of NSAIDs, such as loxoprofen, diclofenac, and etodolac, and with dual therapy using NSAIDs or antiplatelet drugs 4.
• The exact mechanism by which analgesics increase the risk of diverticular disease complications is not fully understood, but it is thought to be related to the inhibition of prostaglandin synthesis and the alteration of the protective lining of the colon 2, 3, 4, 5, 6.

Specific Analgesics and Diverticular Disease

• NSAIDs: associated with an increased risk of diverticulitis and diverticular bleeding 3, 4, 6.
• Acetaminophen: associated with an increased risk of symptomatic diverticular disease, particularly bleeding 2.
• Aspirin: associated with an increased risk of diverticulitis and diverticular bleeding, even at low doses 3, 4.
• Opioid analgesics: associated with an increased risk of perforated colonic diverticular disease 5.
• Corticosteroids: associated with an increased risk of perforated colonic diverticular disease 5.