Analgesic Effects Of Nonsteroidal Anti-inflammatory Drugs Research Articles

A Novel Pain Relief Approach for the Treatment of Multiple Dental Caries and Pulpitis

Anxiety and stress toward treatment can hamper treatment completion in patients with dental caries and pulpitis. Therefore, effective management of post-treatment pain is important because poor pain management can lead to patient dissatisfaction. Ultrasound-guided nerve blocks provide good postoperative analgesia in maxillofacial surgeries. These surgeries can be performed under general or local anesthesia without complications. Here, we present the case of a patient with dental phobia who was successfully treated with these techniques. The patient was a 22-year-old woman with a history of manic-depressive illness who presented with 23 decayed teeth. She had previously undergone vital pulp therapy; however, post-treatment pain led to treatment-related stress, and the patient discontinued the dental treatment. She preferred the dental treatment to be completed with as little pain as possible and wanted to avoid a pulpectomy. The patient’s history of heavy use of non-steroidal anti-inflammatory drugs (NSAIDs) made her resistant to NSAIDs. As a result, the analgesic effect of NSAIDs could not be expected. After intravenous midazolam and propofol sedation, an ultrasound-guided inferior alveolar nerve block was performed bilaterally, and 0.375% ropivacaine was used as a local anesthetic. The patient did not complain of post-operative pain, and no post-operative analgesics were required.

Нестероидные противовоспалительные средства: ключевые механизмы действия и нейропротективный потенциал

Нестероидные противовоспалительные средства (НПВС) применяются для купирования болевого синдрома при многочисленных патологических состояниях — головной, зубной, мышечной боли, а также для лечения воспалительных процессов и в качестве жаропонижающих препаратов. Противовоспалительный и анальгезирующий эффекты взаимосвязаны, при этом противовоспалительный эффект доминирует. Основным механизмом действия НПВС является ингибирование биосинтеза простагландинов (ПГ), участвующих в развитии воспаления и болевого синдрома. Влиянием на синтез ПГ обусловлен основной побочный эффект НПВС — ульцерогенное действие. В настоящее время поиск новых НПВС направлен на минимизацию нежелательных реакций при сохранении всех основных фармакологических эффектов. Целью обзора являлись: 1) оценка и анализ перечня применяющихся в РФ НПВС, механизм действия, показания к их применению, возможные нежелательные эффекты, молекулярные, клеточные и функциональные мишени действия НПВС, возможности и перспективы поиска новых безопасных средств, обладающих противовоспалительной активностью; 2) характеристика особенности реализации эффектов ПНВС в центральной нервной системе.

The efficacy of meloxicam in acute back pain: results of an observational non-interventional multicenter study

To evaluate the efficacy of non-steroidal anti-inflammatory drugs (NSAIDs) (meloxicam) in acute nonspecific back pain (NSBP) depending on influence of clinical and anamnestic factors. The studied group included 2078 patients presented with an acute NSBP. All study subjects received meloxicam in a dose of 15 mg/day: 86.1% were given intramuscular meloxicam injections for the first 3-5 days and then switched to an oral meloxicam and 13.9% received an oral meloxicam throughout the therapy. Skeletal muscle relaxants (SMR) and oral or intramuscular group B vitamins were also prescribed to 52.3% and 17.4% of study patients, respectively. Pain was assessed on a 10-point numerical rank scale (NRS). The study assessed the rate of complete pain relief within a 2-weeks NSAID therapy. Complete pain relief was achieved in 75.2% of study patients, mean period of treatment was 8.61±5.53 days. Adverse events were observed in 4.6% of patients. Age <65 years, first NSBP episode and a history of good response to NSAIDs were associated with better treatment outcomes. A severe baseline pain (NRS score ≥7), pain persistence at rest, at nights and, especially, sciatica were associated with poorer treatment outcomes. Co-administration of SMR and group B vitamins did not increase chances for pain relief compared to the NSAID monotherapy. Meloxicam in a dose of 15 mg/day is an effective and safe therapy for the treatment of acute NSBP. The analgesic effect of NSAIDs is higher in young patients, patients with the first episode of NBC and a good response to NSAIDs in history. Treatment of patients with NSBP in the presence of severe pain, maintaining pain at rest and at night, and in case of sciatica, requires special control and integrated treatment.

Combination therapy for pain in musculoskeletal diseases

When managing patients with locomotor pathology, serious attention is paid to symptomatic therapy aimed at eliminating the unpleasant manifestations of the disease. At the same time, rational analgesia is of the greatest importance. If acute pain should be arrested, parenteral or tableted formulations of fast-acting analgesics are used for days. Longer analgesic therapy especially for clinically relevant inflammation is based on the use of nonsteroidal anti-inflammatory drugs (NSAID) having analgesic and anti-inflammatory effectiveness and good tolerance. The level of analgesia may be increased, by combining NSAID with tramadol and paracetamol. When clinical muscular spasm is implicated in the pathogenesis of chronic pain, it is expedient to prescribe myorelaxants that have an analgesic potential and are able to potentiate the analgesic effect of NSAID.

Therapy for back pain syndrome

There is evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) may be used in combination with B group vitamins. A number of independent trials demonstrates that B group vitamins potentiate the analgesic effect of NSAIDs and contribute to a rapider regression of pain syndrome than their monotherapy. To reduce the risk of adverse reactions of NSAID therapy, to enhance its adherence, and to reduce its cost, it is reasonable to administer combination drugs that contain these components and allow the dose of active substances to be decreased due to their synergism. The new combination drug neurodiclovit contains slow-release enteric-coated granules and individual immediate-release granules of vitamins B 1, B 6, and B 12. Incorporation of neurodiclovit into treatment regimens for back pain syndromes will promote optimization of their therapy.

Pregnant women and non-steroidal anti-inflammatory drugs: Knowledge, perception and drug consumption pattern during pregnancy in Ethiopia

Background:Non-steroidal anti-inflammatory drugs (NSAIDs) are among the widely used drugs and are often used by pregnant women. However, they can have significant teratogenic effects. The aim of the study was to investigate pregnant women's knowledge about NSAIDs use during pregnancy and their perception and consumption pattern.Materials and Methods:The study was a cross sectional study on women waiting for a consultation in the selected maternity hospitals in Addis Ababa, Ethiopia. The pregnant women were selected randomly and then interviewed by using standardized questionnaires.Result:A total of 224 pregnant women were involved in the study. Out of those, 203 (90.6%) of them have taken NSAIDs since the beginning of their pregnancy. About 201 (89.7%), 198 (88.4%) and 189 (84.4%) of the pregnant women considered that ibuprofen, diclofenac and aspirin are not NSAIDs respectively. Regarding analgesic effect of NSAIDs, 97 (43.3%) of the pregnant women believed that NSAIDs are effective for treating pain. Acetaminophen was considered as the most effective treatment for pain by 84 (37.50%) of the patients.Conclusion:Acetaminophen is the most common analgesic that was taken by most pregnant women. The knowledge of pregnant women about NSAIDs is poor.

The COXIB Experience: A Look in the Rearview Mirror

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used prescription and nonprescription drugs in the world. The discovery of cyclooxygenase (COX) as the target of NSAIDs, the subsequent identification of two isoforms of COX (COX-1 and COX-2), and studies of their regulation and sites of expression led to the hypothesis that COX-2 is the molecular target for the anti-inflammatory and analgesic effects of NSAIDs. A corollary was that COX-2-selective inhibitors (COXIBs) would retain the desirable effects of NSAIDs without some of their liabilities (e.g., gastrointestinal toxicity, which was ascribed to COX-1 inhibition). The first marketed COXIBs exhibited reduced gastrointestinal side effects relative to traditional NSAIDs and were enormous commercial successes. However, clinical trials testing the hypothesis that COXIBs prevent recurrence of premalignant colon polyps uncovered adverse cardiovascular effects that are mechanism based. This review provides an overview of the discovery, development, and difficulties of the COXIBs, a perspective on what has been learned, and speculation on the way forward.

Spinal serotonergic system is partially involved in antinociception induced by Trigonella foenum-graecum (TFG) leaf extract

It has been reported that Trigonella foenum-graecum (TFG) extract exerts analgesic, anti-inflammatory and anti-pyretic effects in different experimental models. The major objective of this paper was to investigate the site and mechanism of the analgesia induced by Trigonella foenum-graecum extract. We studied the analgesic effects of different doses of Trigonella foenum-graecum extract after i.p., i.t. and i.c.v. administration in formalin test, using male NMRI rats (200–250 g). Trigonella foenum-graecum extract showed analgesic effects in i.p. (1 g/kg) and i.t. (0.5, 1, and 2 mg/rat) ( P < 0.05 in all groups) but not in i.c.v. (1 and 3 mg/rat) administrations. Based on the similarities between the effects of Trigonella foenum-graecum extract with those of nonsteroidal anti-inflammatory drugs (NSAIDs) and the role of 5-HT system in analgesic effects of NSAIDs, we tried to investigate the role of spinal 5-HT system in analgesic effects of Trigonella foenum-graecum extract. After lesioning of spinal 5-HT system by 5,7-dihydroxytryptamine (5,7-DHT), it was shown that the analgesic effect of Trigonella foenum-graecum extract (0.5 and 3 mg/rat) in the second phase of formalin test, was abolished completely and reduced relatively after using a low-dose (0.5 mg/rat) and a high-dose (3 mg/rat), respectively ( P < 0.05). So, the antinociception partially remained ( P < 0.05) after using the latter dose. Meanwhile, administration of naloxone (2 mg/kg, i.p.) had no effect on the Trigonella foenum-graecum extract (1 g/kg, i.p.) analgesia. In conclusion, this study confirms the central action of Trigonella foenum-graecum extract and that spinal 5-HT system is partially involved in the analgesia induced by it in the second phase of formalin test and also indicates for co-existence of other analgesic mechanism(s).

Anti-Inflammatory Effect and Low Ulcerogenic Activity of Etodolac, a Cyclooxygenase-2 Selective Non-Steroidal Anti-Inflammatory Drug, on Adjuvant-Induced Arthritis in Rats

Adjuvant arthritic rats are known to be more susceptible to gastric damage induced by non-steroidal anti-inflammatory drugs (NSAIDs) than are normal rats. We compared the relative gastric safety profile of etodolac with those of meloxicam, diclofenac sodium and indometacin in adjuvant arthritic rats and normal rats or mice. As a measure of the safety profiles of NSAIDs, we used the safety index, the ratio of the dose that elicits gastric mucosal lesions to the effective dose as an anti-inflammatory or analgesic compound. The anti-inflammatory or analgesic effects of NSAIDs were assessed by paw swelling in adjuvant arthritic rats, and either carrageenin-induced paw edema or brewer’s yeast-induced hyperalgesia, as well as acetic acid-induced writhing, in normal rats or mice. In addition, we also investigated the effects of these NSAIDs on human COX-1 and COX-2 activity. Etodolac and other NSAIDs inhibited paw swelling and caused gastric mucosal lesions in adjuvant arthritic rats in a dose-dependent manner. Etodolac showed the highest UD₅₀ value and safety index among these NSAIDs in arthritic rats. In normal rats, etodolac also showed the highest UD₅₀ value and safety index, except when its effects were assessed by acetic acid-induced writhing. Etodolac and meloxicam showed selectivity for human COX-2 over COX-1. In contrast, diclofenac sodium and indometacin were selective for COX-1. These results suggest that etodolac, a COX-2 selective NSAID, has anti-inflammatory effects with a better safety profile for the stomach than do non-selective NSAIDs, including diclofenac sodium and indometacin, in adjuvant arthritic as well as normal rats.

Toward Defining the Analgesic Role of Nonsteroidal Anti-inflammatory Drugs in the Management of Acute Soft Tissue Injuries

Abstract: Although nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for the management of soft tissue injuries, much of the world literature defining their usefulness for this indication is conflictual, vague, and uninstructive. Although differences in methodology between studies is an important factor, pharmacological differences between NSAIDs may be more important in explaining the clinical results. The authors challenge the traditional view that the analgesic effect of NSAIDs can be universally attributed to their inhibitory effects on the synthesis of peripherally formed prostaglandins. Much of our understanding of postinjury pain, hyperalgesia, and allodynia has been derived from studies performed on skin. Such findings may not be appropriate to trauma in deeper tissue. Recent clinical evidence is reviewed which supports the concept that peripheral events alone cannot adequately account for the phenomena of hyperalgesia and allodynia following injury to joints and muscle. A corollary of these findings is that in the management of acute pain, pharmacological intervention may be less effective when aimed solely at peripheral events, such as prostaglandin synthesis. In our survey we critically review the results of 26 different studies which were conducted under double-blind conditions and included a placebo control group. Of these, 14 studies demonstrated a significant difference between NSAID and placebo for nine NSAIDs—azapropazone, clonixin, ketoprofen, naproxen, diclofenac, fenbufen, ibuprofen, indomethacin, and piroxicam. In those studies where concomitant physical therapy was administered, we identified four NSAIDs which were demonstrated unequivocably to provide additional benefit–azapropazone, clonixin, ketoprofen, and naproxen. In the light of these findings we discuss the emerging view that, at least for some NSAIDs, effects on nociceptive pathways independent of prostaglandin synthesis may explain their analgesic character.

Hyperalgesia mediated by spinal glutamate or substance P receptor blocked by spinal cyclooxygenase inhibition.

Inhibition of cyclooxygenase by nonsteroidal anti-inflammatory drugs (NSAIDs) in the periphery is commonly accepted as the primary mechanism by which these agents produce a selective attenuation of pain (analgesia). NSAIDs are now shown to exert a direct spinal action by blocking the excessive sensitivity to pain (hyperalgesia) induced by the activation of spinal glutamate and substance P receptors. These findings demonstrate that the analgesic effects of NSAIDs can be dissociated from their anti-inflammatory actions. Spinal prostanoids are thus critical for the augmented processing of pain information at the spinal level.