Controversies and advances in non-steroidal anti-inflammatory drug (NSAID) analgesia in chronic pain management

Abstract

Chronic pain can lead to significant disability with social and economic implications in the community. Traditional non-steroidal anti-inflammatory drugs (NSAIDs) have been part of the management of chronic pain. The risk of adverse events with traditional NSAIDs has led to the development of alternative therapeutic options.

Soluble epoxide hydrolase as a therapeutic target for pain, inflammatory and neurodegenerative diseases

“…The well described gastrointestinal (GI) ulceration produced by NSAID use is not trivial given the significant rate of hospitalization and death associated with GI bleeding, particularly in elderly patients (Lazzaroni & Bianchi Porro, 2004; Shah & Mehta, 2012). There are also cardiovascular effects of NSAIDs including the selective COX-2 inhibitors that were thought to spare the GI side effects (Lazzaroni & Bianchi Porro, 2004).…”

Anti‐Inflammatory Property of the Ethanol Extract of the Root and Rhizome of Pogostemon cablin (Blanco) Benth

“…Nowadays, nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed therapeutics for the treatment of inflammatory diseases [3]. However, owing to the adverse side effects such as gastrointestinal ulcers, hemorrhage, and renal damages induced by long-term administration, the use of NSAIDs is becoming highly controversial [3, 4]. Therefore, increasing attention has being focused on the ethnological medicinal plants as they are affordable and with less toxicities and adverse effects [5].…”

Advances in pain management

“…In this issue, Shah and Mehta (see page ) provide an in-depth assessment of the problems associated with systemic NSAIDs and go on to discuss innovations in NSAID therapy designed to improve safety and tolerability, such as topical preparations and gastro-protective formulations 10. Gastrointestinal complications are four times more likely to occur in people taking NSAIDs than in those who do not.…”

“…Shah and Mehta proceed to review potential strategies to improve the safety of NSAID therapy, first noting the benefits of topical NSAID preparations 10. These provide an alternative treatment option with superiority to placebo, albeit in relatively short studies (4 weeks to 3 months).…”

“…The review also highlights concomitant gastric protection therapy (misoprostol or proton pump inhibitors (PPI)) for systemic NSAIDs, especially in at-risk groups of patients 10. Recently, fixed-dose NSAID–PPI combinations have been developed with the aim of improved adherence to therapy and reduced tablet burden for the patient 14.…”