"The shifting sands of NSAIDs: Guiding Lights"
Musculoskeletal pain is prevalent especially in the elderly.
- NSAIDs are very effective agents for managing this type of pain.
- The toxicity profile of NSAIDs is well known: dyspepsia is common; peptic
ulceration is fairly common; GI bleeding and ulcer perforation is uncommon.
- The widespread use of NSAIDs means that even uncommon side effects are
frequently seen (estimated 2000 deaths/year in UK and many thousands of
- COXIBs have much lower upper GI adverse effects than standard NSAIDs but
are no more potent than standard NSAIDs. They are much more expensive.
- A small but definite increased risk of CVD has altered the overall
risk-benefit analysis for these agents and led to the withdrawal of rofecoxib
in September 2004.
- There is probably a small increased risk of CVD with other COXIBs.
- Recent population studies have suggested the possibility of a small
increased risk of CVD even in conventional NSAIDs.
- Routine, daily use of NSAIDs and COXIBs should be the exception. The rule
should be intermittent, ‘as required’ use. Drug ‘holidays’ should be
- Always consider alternative management strategies, especially
- NSAIDs and COXIBs will remain potent weapons in our armamentarium for
treating musculoskeletal pain.
- Explain to your patients the potential risks of taking any medication.
They must be made aware of uncertainties and decide for themselves.