Management of Chronic Nonmalignant Pain with Nonsteroidal Antiinflammatory Drugs

Herndon, Christopher M.; Hutchison, R.; Berdine, Hildegarde J.; Stacy, Zachary A.; Chen, Judy T.; Farnsworth, David D.; Dang, Devra K.; Fermo, Joli D.

doi:10.1592/phco.28.6.788

Cited by 24 publications

(10 citation statements)

References 130 publications

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“…Although the rate of NSAID-induced nephrotoxicity has been estimated to be low (1-5%) the NSAIDs, including COX-2 inhibitors, must be used cautiously or not at all in patients with predisposing renal conditions. It is important to monitor blood pressure, weight, and serum creatinine and potassium concentrations when appropriate, use the lowest dose possible, and consider limiting dietary salt intake[624]. …”

Section: Elderly's Particularities and Cautionsmentioning

confidence: 99%

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Pain management in the elderly at the end of life

Dalacorte¹,

Rigo²,

Dalacorte³

2011

North Am J Med Sci

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Background:The treatment of older adults with pain is complex and affected by age-related changes in pharmacokinetics and pharmacodynamics. Chronic pain encompasses a complex array of sensory-discriminatory, motivational-affective, and cognitive-evaluative components. Because of this complexity, both pharmacologic and nonpharmacologic approaches should be considered to treat pain.Aims:Given the large number of older persons with pain at the end of life and the few data about this issue, the objective of this article is to review the treatment of pain in this population.Patients and Methods:We searched The Cochrane Library, MEDLINE and LILACS from 1990 to 2011 and the references in retrieved manuscripts. The search terms were pain AND elderly AND end of life.Results:There are evidences of undertreatment among elderly people. The association of nonpharmacologic resources with the pharmacological treatment can help reduce the use of analgesics minimizing the side effects of long term medication. Pharmacological treatment is escalated in an orderly manner from non-opioid to weak opioid to strong opioid. Adjuvant drugs like anticonvulsants and antidepressants may be necessary.Conclusions:The sequential use of analgesics drugs and opioids are considered effective and relatively inexpensive for relieving pain, but no well designed specific studies in the elderly patient are available. There are not specific recommendations about the long-term use of complementary and alternative therapies and although their effectiveness remains unproven they should not be discouraged. Palliative sedation may be a valid palliative care option to relieve suffering in the imminently dying patient.

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Section: Elderly's Particularities and Cautionsmentioning

confidence: 99%

“…Because of this complexity, both pharmacologic and nonpharmacologic approaches should be considered to treat pain[6]. …”

Section: Introductionmentioning

confidence: 99%

Pain management in the elderly at the end of life

Dalacorte¹,

Rigo²,

Dalacorte³

2011

North Am J Med Sci

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“…Nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for many of these individuals [Herndon et al 2008]. Worldwide, over 73,000,000 prescriptions for NSAIDS are written yearly [Biederman, 2005] Abstract: Chronic pain conditions affect at least 116 million US adults and more than onethird of adults worldwide.…”

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confidence: 99%

DUEXIS^® (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug

Bello

2012

Therapeutic Advances in Musculoskeletal

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327 IntroductionChronic pain conditions affect at least 116 million US adults and more than one-third of adults worldwide [IOM, 2011;Tsang et al. 2008]. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a mainstay of therapy for many of these individuals [Herndon et al. 2008]. Worldwide, over 73,000,000 prescriptions for NSAIDS are written yearly [Biederman, 2005] Abstract: Chronic pain conditions affect at least 116 million US adults and more than onethird of adults worldwide. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used extensively for the treatment of chronic pain due to their efficacy as anti-inflammatory and analgesic agents. Gastrointestinal toxicity is the most well known adverse effect of NSAID therapy and it may manifest as dyspepsia, ulcers, or bleeding. Current guidelines for the management of patients who require NSAIDs for chronic pain and inflammation recognize the potential toxicity associated with these drugs and the need for gastroprotection. DUEXIS ® (ibuprofen 800 mg, famotidine 26.6 mg) is a proprietary combination, immediate release tablet containing 800 mg of ibuprofen and 26.6 mg of famotidine. The efficacy of DUEXIS ® taken three times daily has been demonstrated in two large-scale controlled clinical trials (Registration Endoscopic Studies to Determine Ulcer Formation of HZT-501 Compared with Ibuprofen: Efficacy and Safety Studies (REDUCE) and REDUCE-2) which showed that this new formulation significantly reduced the risk of endoscopic upper gastrointestinal ulcers compared with ibuprofen alone (REDUCE-1, p < 0.0001, REDUCE-2, p <0.05). DUEXIS ® was also superior to ibuprofen in decreasing the risk for gastric ulcers (REDUCE-1, p < 0.001, REDUCE-2, p < 0.05) as well as duodenal ulcers (REDUCE-1, p < 0.05, REDUCE-2, p < 0.05). Safety results from these two studies indicated that treatment-emergent adverse events occurred in 55% of patients treated with DUEXIS ® versus 58.7% for ibuprofen, and serious adverse events were recorded for 3.2% of patients treated with DUEXIS ® versus 3.3% of those on ibuprofen. Adverse events leading to discontinuation occurred in 6.7% of patients treated with DUEXIS ® and 7.6% for ibuprofen. The combination of ibuprofen and famotidine in a single tablet has the potential to improve adherence to gastroprotective therapy in patients who require NSAID treatment and the use of a histamine type 2 receptor antagonist rather than a proton-pump inhibitor may decrease the risk for clinically significant drug interactions and adverse events (e.g. interaction with clopidogrel, fracture, pneumonia, Clostridium difficile infection).

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“…The effectiveness of using NSAID in the treatment of chronic low back pain is questionable [26–28]. Some papers suggest a small improvement in wellbeing and a reduced subjective pain sensation in patients using certain NSAIDs when compared with the control group (placebo) [29, 30].…”

Section: Discussionmentioning

confidence: 99%

Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial

Majchrzycki

Kocur

Kotwicki

2014

The Scientific World Journal

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Objective. To investigate whether chronic low back pain therapy with deep tissue massage (DTM) gives similar results to combined therapy consisting of DTM and non-steroid anti-inflammatory drugs (NSAID). Design. Prospective controlled randomized single blinded trial. Settings. Ambulatory care of rehabilitation. Participants. 59 patients, age 51.8 ± 9.0 years, with chronic low back pain. Interventions. 2 weeks of DTM in the treatment group (TG) versus 2 weeks of DTM combined with NSAID in the control group (CG). Main Outcome Measures. Visual analogue scale, Oswestry disability index (ODI), and Roland-Morris questionnaire (RM). Results. In both the TG and the CG, a significant pain reduction and function improvement were observed. VAS decreased from 58.3 ± 18.2 to 42.2 ± 21.1 (TG) and from 51.8 ± 18.8 to 30.6 ± 21.9 (CG). RM value decreased from 9.8 ± 5.1 to 6.4 ± 4.4 (TG), and from 9.3 ± 5.5 to 6.1 ± 4.6 (CG). ODI value decreased from 29.2 ± 17.3 to 21.4 ± 15.1 (TG) and from 21.4 ± 9.4 to 16.6 ± 9.4 (CG). All pre-post-treatment differences were significant; however, there was no significant difference between the TG and the CG. Conclusion. DTM had a positive effect on reducing pain in patients with chronic low back pain. Concurrent use of DTM and NSAID contributed to low back pain reduction in a similar degree that the DTM did.

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Management of Chronic Nonmalignant Pain with Nonsteroidal Antiinflammatory Drugs

Cited by 24 publications

References 130 publications

Pain management in the elderly at the end of life

Pain management in the elderly at the end of life

DUEXIS^® (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug

Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial

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Management of Chronic Nonmalignant Pain with Nonsteroidal Antiinflammatory Drugs

Cited by 24 publications

References 130 publications

Pain management in the elderly at the end of life

Pain management in the elderly at the end of life

DUEXIS® (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug

Deep Tissue Massage and Nonsteroidal Anti-Inflammatory Drugs for Low Back Pain: A Prospective Randomized Trial

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Product

Resources

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DUEXIS^® (ibuprofen 800 mg, famotidine 26.6 mg): a new approach to gastroprotection for patients with chronic pain and inflammation who require treatment with a nonsteroidal anti-inflammatory drug