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REVIEW - Current state of therapy for pain and inflammation

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Review

Current state of therapy for pain and inflammation

Arthritis Research & Therapy 2005, 7(Suppl 4):S1-S6

doi:10.1186/ar1792

Published 15 September 2005

Nonsteroidal anti-inflammatory drugs (NSAIDs), including both

traditional nonselective NSAIDs and the selective cyclo-oxygenase (COX)-2

inhibitors, are among the most widely used medications in the USA.

Traditional NSAIDs, although effective at relieving pain and inflammation,

are associated with a significant increase in the risk for gastrointestinal

adverse events. Throughout the 1990s these events were estimated to result

in approximately 100,000 hospitalizations and 16,500 deaths each year

nationally. Recent studies have indicated that the risk for serious NSAID

gastropathy has declined substantially during the past decade as a result of

a number of factors, including lower doses of NSAIDs, the use of

gastroprotective agents such as proton pump inhibitors and misoprostol, and

the introduction of the selective COX-2 inhibitors. One therapeutic approach

that may reduce the risk for gastrointestinal side effects associated with

traditional NSAIDs while retaining their efficacy is the inclusion of

co-therapy with a proton pump inhibitor; these agents inhibit acid secretion

and have been demonstrated to promote ulcer healing in patients with

NSAID-related gastric ulcers. Alternatively, COX-2 selective agents have

been used to treat patients at high risk for such events. Both nonselective

and selective COX-2 inhibitors have now been shown to be associated with an

increased risk for cardiovascular events. These studies, together with the

outcomes of the recent US Food and Drug Administration decision to require

'black box' warnings regarding potential cardiovascular risks associated

with NSAIDs, suggest that the use of COX-2 inhibitors as the sole strategy

for gastroprotection in patients with arthritis and other pain syndromes

must be reconsidered, particularly among those at risk for cardiovascular

events.

To read more, see:

http://arthritis-research.com/content/7/S4/S1#B9

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

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