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NSAIDs: Rx Considerations, Concerns, and Cautions

Management of Chronic Nonmalignant Pain with Nonsteroidal Anti-inflammatory Drugs

Herndon CM, Hutchison RW, Hildegarde JB, et al. Pharmacotherapy. 2008;28(6):788-805.

Download PDF: http://www.accp.com/docs/positions/opinionPapers/Pharm2806_Herndon-NSAIDs.pdf (18 pp)

This joint statement by 3 special interest groups of the American College of Clinical Pharmacy examines the use of nonsteroidal anti-inflammatory drugs (NSAIDs) for several chronic pain syndromes—including osteoarthritis, rheumatoid arthritis, low back pain, fibromyalgia, and peripheral neuropathy. The paper offers an interesting discussion of the pharmacology of all anti-inflammatory agents; however, insufficient research evidence was found in the literature to solidly recommend these drugs for the treatment of chronic pain conditions. Accessed November 26, 2008.

Use of Nonsteroidal Anti-inflammatory Drugs. An Update for Clinicians. A Scientific Statement From the American Heart Association

Antman EM, et al. Circulation 2007, published online February 26, 2007.

PDF available here for download: AHA_NSAID_Statement_Feb07.pdf  (674 KB, 10 pp)

In this statement from the American Heart Association (AHA), healthcare providers are cautioned to change their approach in prescribing pain relievers for patients at risk of heart disease. Non-pharmacological approaches -- physical therapy, exercise, weight loss, orthotics, and heat or cold therapy -- should be considered for initial treatment of musculoskeletal symptoms that result from tendonitis or bursitis, degenerative joint problems (osteoarthritis), and inflammatory joint problems (rheumatoid arthritis). When choosing medications, the least risky should be tried first, usually acetaminophen or aspirin, at the lowest effective dose. Despite potential for abuse, a role remains for opioid analgesics in providing short-term pain relief. Long-term, high-dose medication therapy is more complex, and risks of gastrointestinal and/or cardiovascular or cerebrovascular complications associated with certain NSAIDs must be considered. A stepped-care approach to pharmacologic therapy is described.

Choosing Non-Opioid Analgesics for Osteoarthritis: Clinician's Guide

U.S. Agency for Healthcare Research and Quality; January 2007.

PDF available here for download: NonOpioids_Osteoarth_Clin.pdf  (389 KB, 4 pp)

This concise guide from a very reputable source summarizes clinical evidence on the effectiveness and safety of non-opioid analgesics for osteoarthritis. The most common OTC products and prescription NSAIDs are described, taking into account benefits, risks, and costs. The document does not address non-pharmacologic therapies such as diet, exercise, acupuncture, surgical interventions, or others.

Also available, a companion booklet for patients....
Choosing Pain Medicine for Osteoarthritis: A Guide for Consumers. See details...>

Medication Guide for Nonsteroidal Anti-inflammatory Drugs (NSAIDS)

U.S. Food & Drug Administration, February 2007

PDF available here for download: NSAID_med_guideFDA.pdf  (558 KB, 3 pp)

This FDA-approved sample Medication Guide for patients discusses, in question and answer format, concerns regarding the use of NSAIDs. Side effects are listed, and the document advises that NSAIDs may increase chances of a heart attack or stroke that can lead to death, or may cause gastrointestinal ulcers and bleeding at any time during treatment. A list of prescription NSAIDs is included, and precautions for patients to follow are provided.

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