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The British Medical Journal published research in June warning that prescription-strength daily doses of the painkillers could cause an extra three people out of 1,000 to develop heart attack or stroke, but the caution did not cover over-the-counter, relatively low doses of the painkillers.

The drugs -- classified as non-steroidal anti-inflammatory drugs (NSAIDs) -- are used by millions of UK citizens to treat chronic pain and arthritis.

The Commission on Human Medicine reviewed 11 common pain drugs -- diclofenac, etodolac, ibuprofen, indomethacin, ketoprofen, ketorolac, meloxicam, nabumetone, naproxen, nimesulide and proxicam -- and found associations between high doses and strokes and heart attacks.

The committee recommended that consumers using the painkillers restrict their use to the lowest possible dose for the shortest period of time. The recommendations were accepted by the UK's drug safety body -- the Medicines and Healthcare products Regulatory Agency (MHRA) -- which is in the process of writing to NSAID manufacturers.

Though Dr. June Raine, MHRA's director of vigilance and risk management, said her agency still finds that the advantages of NSAIDs outweigh the risks, she recommended consumers follow the commission's advice in reducing the dosage and length of use of the drugs.

"Anyone who is concerned about their treatment should talk to their doctor in the first instance," Raine said.

The European Medicines Agency (EMEA) examined the commission's evidence and ruled that the risks associated with the drugs are relatively low, but still urged NSAID users to use the painkillers on a less frequent basis and in lower doses.

"There has been a mounting body of evidence that taking high doses of NSAIDs increases the chances of having a heart attack," said Ellen Mason, a cardiac nurse at the British Heart Foundation. "However, the increased risk is small, and the EMEA have concluded that it is outweighed by the benefits of pain relief for patients with conditions such as arthritis."

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