Coxibs: Evolving role in pain management.
Traditional pain management strategies have relied on the use of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and acetaminophen, as well as other adjuvant analgesics. However, the limited activity of these drugs and the substantial adverse effects associated with their use has left many patients without dependable options for effective treatment. Recent advances in the understanding of pain and its pathophysiologic mechanisms have led to the development of novel therapeutic options. Cyclooxygenase (COX)-2-specific inhibitors (coxibs) have an established efficacy in the treatment of chronic arthritic pain comparable to that of traditional NSAIDs, without the degree of gastrointestinal (GI) complications commonly attributed to NSAID use. Recent trials also have shown the effectiveness of 1 of the coxibs for relief of chronic lower back pain. Numerous studies have shown that coxibs are efficacious for the management of acute pain in various clinical settings, including orthopedic surgery, dental surgery, and dysmenorrhea. The superior safety profile of coxibs in conjunction with a comparable efficacy to nonselective NSAIDs supports the use of coxibs in balanced analgesic regimens. Decreased GI and antiplatelet effects of coxibs compared to traditional NSAIDs provide the potential to incorporate coxibs into the pain management algorithm used to treat cancer pain.
Katz
Nathaniel
N
Department of Anesthesia, Harvard Medical School, Boston, MA, USA.
D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004412:Dysmenorrhea / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008565:Membrane Proteins; D019647:Oral Surgical Procedures / Q000009:adverse effects; D019637:Orthopedic Procedures / Q000009:adverse effects; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D011451:Prostaglandin-Endoperoxide Synthases
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases