Management of chronic nonmalignant pain with nonsteroidal antiinflammatory drugs. Joint opinion statement of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy.
Chronic nonmalignant pain is a major burden on the health care system in the United States. Frequently, nonsteroidal antiinflammatory drugs (NSAIDs) are used to assist in the management of various chronic pain syndromes. Although evidence is accumulating on the potential toxicities associated with NSAIDs, clear recommendations are lacking to guide the appropriate use of these drugs. Equivocal data, especially with respect to cardiovascular risk, further confuse a clear treatment pathway when assessing pharmacotherapy. Originally, cyclooxygenase selectivity appeared to be a determining factor in choosing an agent because of the presumed lack of effect on the cardiovascular and gastrointestinal renal systems. This theory, however, was recently dispelled. To provide guidance on the selection of an NSAID for various chronic pain syndromes, members of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy evaluated evidence-based use of NSAIDs for frequently encountered pain syndromes, with special focus on the adverse effects of this class of agents.
Herndon
Christopher M
CM
School of Pharmacy, Southern Illinois University-Edwardsville, Edwardsville, Illinois, USA. cherndo@siue.edu
Hutchison
Rob W
RW
Berdine
Hildegarde J
HJ
Stacy
Zachary A
ZA
Chen
Judy T
JT
Farnsworth
David D
DD
Dang
Devra
D
Fermo
Joli D
JD
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D002319:Cardiovascular System / Q000187:drug effects; D002908:Chronic Disease; D005356:Fibromyalgia / Q000188:drug therapy; D041981:Gastrointestinal Tract / Q000187:drug effects; D006801:Humans; D017116:Low Back Pain / Q000188:drug therapy; D010003:Osteoarthritis / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy* / Q000503:physiopathology; D010523:Peripheral Nervous System Diseases / Q000188:drug therapy
D000894:Anti-Inflammatory Agents, Non-Steroidal