Because of the prominence of
pain-related conditions and the growing complexities of clinical management we aimed to explore and attempt to dispel the several myths that surround these serious therapeutic issues.
AIMS: Current myths were identified based on the authors' clinical, scientific, and academic experience. Each contributor addressed specific topics and made his own selection of primary references and systematic reviews by searching in MEDLINE, EMBASE, and CINAHL databases (1990-2008) as well as in the proceedings of the major digestive and rheumatology meetings. The writing and references provided by each contributor were collectively analyzed and discussed by all authors during several meetings until the final manuscript was prepared and approved.
RESULTS:
Pain relief must be considered a human right, and patients with
osteoarthritis pain should be treated appropriately with
analgesic or/and anti-inflammatory drugs. The risk of gastrointestinal (GI) complications with traditional non-steroidal anti-inflammatory drugs (t-
NSAIDs) is present from the first dose (with both short-term and long-term use), and strategies to prevent GI complications should be considered regardless of the
duration of therapy. Compared with t-
NSAIDs,
coxib use is associated with a small but significant reduction of
dyspepsia. While protecting the stomach,
proton pump inhibitors do not prevent
NSAID-induced intestinal damage. To this end,
coxib therapy could be the preferred option, although further randomized studies are needed. A substantial number of patients who need
NSAIDs are also taking low-dose
aspirin for cardiovascular prophylaxis. From a GI perspective, the combination of
aspirin plus a
coxib provides a preferred option compared with
aspirin plus a t-
NSAID, for patients at high GI risk. As the incidence of renovascular adverse effects with t-
NSAIDs and
coxibs is similar, blood pressure should be monitored and managed appropriately in patients taking these drugs, although they should be avoided in those with severe
congestive heart failure. Due to increased cardiovascular risk, which is dependent on the dose,
duration of therapy, and base-line cardiovascular risk, both t-
NSAIDs and
coxibs should be used with caution in patients with underlying prothrombotic states and/or concomitant cardiovascular risk factors.