Non Steroidal Anti-Inflammatory Drugs, NSAIDs


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Non-steroidal anti-inflammatory drugs (NSAIDs) can be extremely effective at reducing inflammation and calming swelling and irritation. NSAIDs are most beneficial in cases of acute pain, or flare-ups in patients with chronic pain.
One of the major benefits to NSAID therapy is that many are available over-the-counter without a prescription.  Included in this category are aspirin (Bayer), ibuprofen (Advil, Motrin), ketoprofen (Orudis KT), and naproxen sodium (Aleve).
In general these should not be used on a daily basis for the treatment of Chronic Pain. When used on a daily basis for a period of several years, there is a risk of damage to the kidneys that can be significant. Furthermore, there is a well-known risk of gastric ulcer formation with NSAIDs. While the newer, COX-2 inhibitors (Celebrex, Vioxx), were designed to avoid this complication, caution should still be used if there is a risk of ulcers or GI bleeding.  Patients with a known history of kidney disease or gastric ulcers should NOT take NSAIDs.
Recently, a new class of NSAIDs has become available, the COX2 inhibitors. Currently available in this class is celecoxib (Celebrex). Selective blockade of cyclooxygenase permits analgesia and an anti-inflammatory effect while minimizing the risk of GI toxicity and bleeding. The COX2 inhibitors have been shown to be equally effective as other NSAIDS, but do not show evidence of greater analgesia (pain relief). The COX2 inhibitors are also considerably more expensive than other over-the-counter NSAIDS.
However, if an NSAID is truly needed and there is concern of GI bleeding, the total cost may be lowered by using one of these agents rather than adding a relatively expensive prophylactic drug such as misoprostol or a pump-inhibitor to counteract the side effects of NSAIDs.  Other COX-2 inhibitors including rofecoxib (Vioxx) and valdecoxib (Bextra) were withdrawn from the market due to potential cardiovascular side effects. 

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In general these should not be used on a daily basis for the treatment of chronic pain. When used on a daily basis for a period of several years, there is a risk of damage to the kidneys that can be significant.
However, a number of acute pain conditions respond well to NSAIDs.  

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NSAIDs are a common pain reliever for many acute conditions. They can be obtained over-the-counter and are generally considered safe. However, if your condition does not respond to this type of medication talk to your doctor about using more reliable chronic pain treatments.