Abstract
Background
In the management of pain, primary care physicians are often the first to diagnose
and treat acute or chronic painful conditions. This places them in an important intersection
to manage pain, in which safe and effective therapeutic options are paramount for
their patients. For decades, NSAIDs have been routinely prescribed for relief of mild
to moderate acute and chronic pain. Yet, safety and tolerability concerns associated
with the use of this class of drugs continue to be an issue for patients and clinicians.
Objective
The objective of this review was to discuss the unmet medical needs of patients in
the management of pain and inflammation, review the dose-dependent safety data associated
with use of NSAIDs, and discuss the need to develop new NSAID formulations to improve
safety and tolerability while maintaining efficacy.
Methods
We performed literature searches of the PubMed and Cochrane Library databases through
December 2012 for articles in English that reported dose-dependent safety and tolerability
data associated with use of NSAIDs.
Results
The risk of serious, dose-dependent adverse events involving the gastrointestinal
tract, cardiovascular system, and kidneys is associated with use of NSAIDs. On the
basis of these findings, the US Food and Drug Administration has requested that the
package insert for all NSAIDs be revised to include a boxed warning highlighting the
potential increased risk of cardiovascular events and the risk of serious, and potentially
life-threatening, gastrointestinal tract bleeding. While using lower dosages of a
particular NSAID may be associated with lower rates of adverse events, maintaining
the clinical efficacy of standard NSAID dosages remains a challenge.
Conclusions
There is a need to develop new and effective NSAID formulations to minimize the safety
and tolerability concerns associated with currently available NSAIDs, yet maintain
efficacy in management of inflammation and pain.
Key words
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Article info
Publication history
Published online: September 03, 2012
Accepted:
August 13,
2012
Identification
Copyright
© 2012 Published by Elsevier Inc.
