The Sjögren's Book by Wallace Daniel J.;

Author:Wallace, Daniel J.;
Language: eng
Format: epub
Publisher: Oxford University Press, Incorporated
Published: 2022-05-15T00:00:00+00:00

What Are the Available Pharmacological and Non-pharmacological Therapies for Chronic Pain?

Nonsteroidal Anti-inflammatory Drugs

The analgesic and anti-inflammatory effect of nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., Motrin, ibuprofen) play a central role in the management of many conditions. It is now known that NSAIDs also act centrally, at least in certain pain states. NSAIDs are primarily indicated for mild to moderate pain, particularly for arthritis, tendinitis, or bursitis. There are many NSAIDs from which to choose. Although their efficacy is similar, an individual’s response to therapy can be highly variable; thus, a patient who does not tolerate or respond to a particular NSAID may do well on another.

The reluctance of many patients and physicians to use NSAIDs is in part due to the many side effects associated with these drugs. Most NSAIDs interfere with platelet aggregation and may cause bleeding. They produce adverse gastrointestinal side effects, including dyspepsia and gastric ulceration. There are also a variety of kidney side effects associated with their use, including salt and water retention and reversible renal insufficiency due to renal vasoconstriction, acute interstitial nephritis, or acute tubular necrosis. Therefore, NSAIDs should be prescribed with caution in patients with hypertension, preexisting renal insufficiency, or heart failure. Other side effects of NSAIDS include hepatic toxicity, confusion, an inability to concentrate, and allergic reactions. Under medical supervision NSAIDs can, however, be prescribed safely and effectively for management of short-term pain or for chronic therapy in selected patients, especially when used on an as-needed basis.

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