NSAID Risks Need to be Considered in Chronic Pain Treatment

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The widespread use of non-steroidal anti-inflammatory drugs (NSAIDS)in the treatment of chronic pain has safety issues that must be considered in order to limit negative impact on mortality and morbidity, according to a new literature review published in the European Journal of Clinical Pharmacology.

NSAIDs are one of the leading causes of drug-related morbidity, especially in the elderly and patients with comorbidities. Most of these adverse effects stem from the generalized inhibition of cyclooxygenases I and II, the major targets of NSAIDs. These enzymes are involved in pain and inflammation pathogenesis; are required in the gastrointestinal (GI) tract for mucosal protection and gut motility; and are needed in the kidneys for functional integrity.

Despite the mechanisms of NSAID toxicity being well understood, the consequences are generally uncontrolled in clinical practice. Chronic high-dose NSAID users may develop GI ulcers, including bleeding ulcers. Renal side effects may lead to renal failure which result in acute dialysis and chronic retention. This includes sodium retention, which can then result in arterial hypertension, heart failure, and atherosclerotic events. In long-term clinical trials, cardiovascular risk may be tripled by chronic high-dose NSAID use. Other side effects include allergic reactions, drug-induced liver injury, and central nervous system effects.

When managing pain and inflammation, the risks associated with NSAID toxicity must be considered. Low-dose/short term use, alternative drugs, or therapy approaches should be considered as alternative options. Therapy options include physiotherapy, exercise, neurophysiologic measures, and local therapies.

NSAID Risks Need to be Considered in Chronic Pain Treatment

Research shows NSAIDs are the leading cause of drug-related morbidity, as their use is often complicated by adverse effects on other systems, especially gastrointestinal and renal functions. This literature review published in the European Journal of Clinical Pharmacology emphasizes safety issues that must be addressed during patient care.

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