Current and emerging treatments for mild/moderate acute ambulatory pain.
Nonsteroidal anti-inflammatory drugs (NSAIDs), the mainstay of therapy for acute musculoskeletal pain, are among the most widely used drugs in the world. The major limitation of traditional (nonselective) NSAIDs is gastrointestinal (GI) toxicity, which includes dyspepsia, mucosal injury, and serious events, such as ulcers, GI bleeding, and perforation. This article reviews the mechanism of action, safety, and efficacy of traditional and selective NSAIDs (coxibs); risk factors for GI complications; and strategies for reducing risk and preventing NSAID-related gastropathy and cardiovascular complications. The article also discusses the use of aspirin for cardioprotection in patients taking analgesic/anti-inflammatory agents for musculoskeletal pain and the need to balance competing GI and cardiovascular risks. Topical NSAIDs and other formulations that may prove to be safer than currently available agents also are addressed.
Weaver
Arthur L
AL
Section of Rheumatology and Immunology, University of Nebraska Medical Center, Omaha, NE, USA. weaver2aj@tds.net
D000208:Acute Disease; D000284:Administration, Oral; D000287:Administration, Topical; D000553:Ambulatory Care; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications; D010146:Pain / Q000188:drug therapy* / Q000209:etiology
D000894:Anti-Inflammatory Agents, Non-Steroidal