Doctors treating people for chronic pain should avoid using all medications – at least at first – the American Heart Association advised Monday in guidelines designed to have a significant impact on the use of medications known as nonsteroidal anti-inflammatory drugs, or NSAIDs.

The scientific statement said that, with the exception of aspirin, there is now strong evidence that NSAIDs are associated with an increased risk of heart attacks and stroke. If 100 patients who have had heart attacks in the past or are at risk for heart disease take these drugs for a year, researchers would expect to see six additional deaths in this group. NSAIDs reduce fever, pain and inflammation.

The statement expressed particular concern about a subgroup of these drugs known as Cox-2 inhibitors. The only drug in this group now on the market in the United States is Celebrex.

The professional association advised patients first be treated with nonmedicinal measures such as physical therapy and orthotics before doctors even consider medication, said the AHA scientific statement.