Long-term NSAID use in primary care: changes over a decade and NICE risk factors for gastrointestinal adverse events

Thompson, Paul; Tee, Lu Hou; McBride, James H.; Quincey, D.; Liddiard, G. Strat

doi:10.1093/rheumatology/kei016

Cited by 28 publications

(13 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To put this in context, it seems that GPs take into account a range of factors, including pain intensity, patient pressure, health economics and adverse outcomes before prescribing (Lanza et al., ). This is especially true when considering NSAIDs, where side effect profile is often more toxic (Schaffer et al., , Thompson et al., ).…”

Section: Discussionmentioning

confidence: 99%

The association between pain intensity and the prescription of analgesics and non‐steroidal anti‐inflammatory drugs

Müller

Bedson

Mallen

2012

European Journal of Pain

View full text Add to dashboard Cite

BackgroundIt is not known whether general practitioners (GPs) prescribe analgesic medication according to intensity of pain or a hierarchical prescribing regimen.AimsThe aim of this study was to assess the association of strength of pain-relief medication prescribed by the GP with the strength of previous prescription and pain level.MethodsThe PROG-RES study collected data on pain intensity in 428 patients aged ≥50 years with non-inflammatory musculoskeletal pain during a consultation with their GP. Prescriptions for analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) were identified on the day of the consultation and in the previous year and were classified as basic, moderate or strong analgesic or NSAID. Regression models were used to assess the association of strength of analgesia and prescription of a NSAID with the strength of previous prescription and the level of pain.ResultsThe majority of patients were not prescribed medication for their pain at the index consultation, but had such a prescription the previous year. There was an association between strength of analgesic and intensity of pain: more intense pain resulted in a stronger drug. This association was attenuated by adjustment for prescribed analgesia in the previous year. There was no association between intensity of pain and NSAID prescription, but previous NSAID prescription predicted another such prescription.ConclusionGPs do not always issue prescriptions for musculoskeletal pain. In cases where a prescription is issued, this is more strongly influenced by previous prescriptions than the patient's pain level. GPs adopt an individualized approach to the treatment of musculoskeletal pain in older adults.

show abstract

Section: Discussionmentioning

confidence: 99%

The association between pain intensity and the prescription of analgesics and non‐steroidal anti‐inflammatory drugs

Müller

Bedson

Mallen

2012

European Journal of Pain

View full text Add to dashboard Cite

show abstract

“…The widespread use of NSAIDs [36], particularly in elderly patients likely to develop cardiac failure [37], makes NSAID-induced cardiac failure an important clinical concern. The risks are comparable to those with left ventricular hypertrophy, diabetes mellitus and valvular heart disease [38,39].…”

Section: Discussionmentioning

confidence: 99%

Non‐steroidal anti‐inflammatory drugs and cardiac failure: meta‐analyses of observational studies and randomised controlled trials

Scott

Kingsley

Scott

2008

European J of Heart Fail

View full text Add to dashboard Cite

Aims: To determine the risks of cardiac failure with non-steroidal anti-inflammatory drugs (NSAIDs) and the specific risks with Cox-2 specific NSAIDs (COXIBs). Methods: We performed meta-analyses examining the risks of developing cardiac failure in observational studies and in randomised controlled trials (RCTs) involving patients with arthritis and non-rheumatic disorders. Electronic databases and published bibliographies were systematically searched (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Results: Five case-control studies (4657 patients, 45,862 controls) showed a non-significant association between NSAIDs and cardiac failure in a random effect model (odds ratio (OR) 1.36; 95% CI 0.99-1.85). Two cohort studies (27,418 patient years, 55,367 control years) showed a significant risk of cardiac failure with NSAIDs (relative risk 1.97; 95% CI 1.73-2.25). Six placebo-controlled trials (naproxen, rofecoxib and celecoxib) in non-rheumatic diseases (15,750 patients) showed more cardiac failure with NSAIDs (Peto OR 2.31; 95% CI 1.34, 4.00). Six RCTs comparing conventional NSAIDs and COXIBs in arthritis (62,653 patients) showed no difference in cardiac failure risk (Peto OR 1.14; 95% CI 0.85-1.53). Conclusion: Observational studies and RCTs all show that NSAIDs increase the risk of cardiac failure. Overall risks are relatively small and are similar with conventional NSAIDs and COXIBs. Pre-existing cardiac failure increases risk.

show abstract

“…In inflammatory diseases, the most common complaint of the patient is accompanying nociception and fever. Although nonsteroidal anti-inflammatory drugs (NSAIDs), especially indomethacin, are the drugs of choice in the treatment of inflammatory diseases [4] and are highly effective, they have a number of deleterious side effects, such as gastrointestinal ulcers and even bleeding [4, 5]. So investigators are still looking for new analgesic drugs with fewer side effects for the treatment of inflammation and nociception.…”

Section: Introductionmentioning

confidence: 99%

Anti-Inflammatory and Antinociceptive Effects of Salbutamol on Acute and Chronic Models of Inflammation in Rats: Involvement of an Antioxidant Mechanism

Uzkeser

Çadırcı

Halıcı

et al. 2012

Mediators of Inflammation

View full text Add to dashboard Cite

The possible role ofβ-2 adrenergic receptors in modulation of inflammatory and nociceptive conditions suggests that theβ-2 adrenergic receptor agonist, salbutamol, may have beneficial anti-inflammatory and analgesic effects. Therefore, in this study, we induced inflammatory and nociceptive responses with carrageenan-induced paw edema or cotton-pellet-induced granuloma models, both of which result in oxidative stress. We hypothesized that salbutamol would prevent inflammatory and nociceptive responses by stimulatingβ-2 adrenergic receptors and the prevention of generation of ROS during the acute inflammation process in rats. Both doses of salbutamol used in the study (1 and 2 mg/kg) effectively blocked the acute inflammation and inflammatory nociception induced by carrageenan. In the cotton-pellet-induced granuloma test, both doses of salbutamol also significantly decreased the weight of granuloma tissue on the cotton pellets when compared to the control. Anti-inflammatory and analgesic effects of salbutamol were found to be comparable with those of indomethacin. Salbutamol decreased myeloperoxidase (MPO) activity and lipid peroxidation (LPO) level and increased the activity of superoxide dismutase (SOD) and level of glutathione (GSH) during the acute phase of inflammation. In conclusion, salbutamol can decrease acute and chronic inflammation, possibly through the stimulation ofβ-2 adrenergic receptors. This anti-inflammatory effect may be of significance in asthma treatment, where inflammation also takes part in the etiopathology. This study reveals that salbutamol has significant antioxidative effects, which at least partially explain its anti-inflammatory capabilities. These findings presented here may also shed light on the roles ofβ-2 adrenergic receptors in inflammatory and hyperalgesic conditions.

show abstract

Long-term NSAID use in primary care: changes over a decade and NICE risk factors for gastrointestinal adverse events

Cited by 28 publications

References 2 publications

The association between pain intensity and the prescription of analgesics and non‐steroidal anti‐inflammatory drugs

The association between pain intensity and the prescription of analgesics and non‐steroidal anti‐inflammatory drugs

Non‐steroidal anti‐inflammatory drugs and cardiac failure: meta‐analyses of observational studies and randomised controlled trials

Anti-Inflammatory and Antinociceptive Effects of Salbutamol on Acute and Chronic Models of Inflammation in Rats: Involvement of an Antioxidant Mechanism

Contact Info

Product

Resources

About