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An Evidence-Based Update on Nonsteroidal Anti-Inflammatory Drugs

C.K.S. Ong, DDS, PhD, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, National University of Singapore, Singapore
P. Lirk, MD, Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Austria
C.H. Tan, MD, PhD, Department of Pharmacology, Faculty of Medicine, National University of Singapore, Singapore
R.A. Seymour, DDS, PhD, Department of Dental Pharmacology, School of Dental Sciences, University of Newcastle upon Tyne, United Kingdom

Reprint Requests: Cliff K.S. Ong, DDS, PhD, Pacific Healthcare, 435 Orchard Road, Suite 11-02, Wisma Atria, Zip 238877, Republic of Singapore, Tel: +65-90492727, Fax: +65-62353227, Email: cliffong{at}pacific.net.sg

Nonsteroidal anti-inflammatory drugs (NSAIDs), including both traditional nonselective NSAIDs and the selective cyclooxygenase (COX)-2 inhibitors, are widely used for their anti-inflammatory and analgesic effects. NSAIDs are a necessary choice in pain management because of the integrated role of the COX pathway in the generation of inflammation and in the biochemical recognition of pain. This group of drugs has recently come under scrutiny because of recent focus in the literature on the various adverse effects that can occur when applying NSAIDs. This review will provide an educational update on the current evidence of the efficacy and adverse effects of NSAIDs. It aims to answer the following questions: (1) are there clinically important differences in the efficacy and safety between the different NSAIDs, (2) if there are differences, which are the ones that are more effective and associated with fewer adverse effects, and (3) which are the effective therapeutic approaches that could reduce the adverse effects of NSAIDs. Finally, an algorithm is proposed which delineates a general decision-making tree to select the most appropriate analgesic for an individual patient based on the evidence reviewed.

Key Words: Analgesics • COX-2 specific inhibitors • NSAIDs • Pain