Prescription Of Nonsteroidal Anti-inflammatory Drugs Research Articles

Suspected Stonefish Envenomation in Reunion Island: 15 Years Later.

Although marine envenomations are a reason for consultation in tropical emergency departments, stonefish stings are particularly feared. Immediate management focuses on pain control, whereas late management addresses cutaneous complications. This study presents a new series and compares the management of these patients and their outcomes at our center over the past 20 years. This study presents a new series of 53 patients treated between 2016 and 2020 at the South Hospital of the University Hospital Center of Réunion following a sting attributed to the stonefish. We compared this new series with a previous series of patients treated at the same center for the same reason between 2001 and 2005. The series are comparable. Regarding early management, the use of regional anesthesia was more frequent (47 vs 3.5%). Half the patients received a strong opioid. Prescription of nonsteroidal anti-inflammatory drugs and corticosteroids persisted. Exposure to a heat source remained common. Prophylactic antibiotics were prescribed more frequently (64 vs 35%) and more uniformly with amoxicillin/clavulanate. Regarding late management, the average duration of hospitalization decreased (1.8 vs 2.6 d). Cutaneous complications were less frequent (9 vs 25%). No patient managed with regional anesthesia presented cutaneous complications. The management of patients in Réunion following Scorpaenidae stings has evolved over time. Regional anesthesia has become more widespread, and the prescription of probabilistic preventive antibiotic therapy is more homogeneous. These changes are associated with a shorter hospital stay and fewer cutaneous complications.

Gestational Exposure to Nonsteroidal Anti-Inflammatory Drugs and Risk of Chronic Kidney Disease in Childhood

Gestational exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of adverse fetal kidney outcomes. However, details regarding timing, specific NSAIDs, and long-term childhood kidney outcomes are limited. To evaluate the association between gestational exposure to NSAIDs and the risk of chronic kidney disease (CKD) in childhood. This national cohort study assessed 1 025 255 children born alive in Taiwan from January 1, 2007, to December 31, 2017, with follow-up until December 31, 2021. Children without valid maternal-child linkage and with incomplete birth information were excluded. Data analysis was performed from November 30, 2023, to April 30, 2024. Maternal prescriptions for NSAIDs from the last menstrual period to birth. The main outcome was childhood CKD, including congenital anomalies of the kidney and urinary tract and other kidney diseases. Cox proportional hazards regression models with stabilized inverse probability of treatment weighting (weighted hazard ratio [wHR]) and a robust sandwich estimator were used to estimate the relative risk of NSAID exposure in pregnancy, adjusted for newborn characteristics. This study included 163 516 singleton-born children (24.0%) whose mothers (mean [SD] age at birth of child, 31.25 [4.92] years) used at least 1 dispensing of an NSAID during pregnancy. Gestational NSAID exposure was significantly associated with a higher risk of childhood CKD (wHR, 1.10; 95% CI, 1.05-1.15). No association was observed between NSAID use and fetal nephrotoxicity in sibling comparisons. Elevated risks were revealed for exposure during the second trimester (wHR, 1.19; 95% CI, 1.11-1.28) and the third trimester (wHR, 1.12; 95% CI, 1.03-1.22) in singleton-born children. Specific NSAID exposures associated with higher CKD risk included indomethacin (wHR, 1.69; 95% CI, 1.10-2.60) and ketorolac (wHR, 1.28; 95% CI, 1.01-1.62) in the first trimester, diclofenac (wHR, 1.27; 95% CI, 1.13-1.42) and mefenamic acid (wHR, 1.29; 95% CI, 1.15-1.46) in the second trimester, and ibuprofen (wHR, 1.34; 95% CI, 1.07-1.68) in the third trimester. In this study, gestational exposure to NSAIDs was not associated with a substantial increase in the risk of childhood CKD when comparing between siblings. However, the findings underscore the need for caution when prescribing NSAIDs during pregnancy, particularly indomethacin and ketorolac in the first trimester, mefenamic acid and diclofenac in the second trimester, and ibuprofen in the third trimester, to ensure the safety of the offspring's kidneys.

Benchmarks for low back pain in general practice in Flanders: electronic audit of INTEGO

BackgroundLow back pain (LBP) is one of the most frequent reasons for encounter in general practice. Yet results from literature show adherence to clinical practice guidelines is low. Audit & feedback is a well-known strategy to improve adherence to guidelines. Benchmarking is an important step in the audit & feedback process. The objective of this study was to develop data-derived benchmarks for low back pain quality indicators.MethodsFour electronic health record extractable quality indicators were selected from an existing indicator set developed by CEBAM, an independent, multidisciplinary and interuniversity medical scientific institute in Belgium. Data from 2021-2022 from INTEGO, a general practice morbidity registry, were used to calculate benchmarks for the four quality indicators. The Achievable Benchmark of Care methodology was used to create benchmarks based on the performance of the 10% best-performing practices.ResultsThe following benchmarks were derived: 4.2% prescription for medical imaging, 12.7% prescription for opioids, 27.2% for prescription for non-steroidal anti-inflammatory drugs or acetaminophen, 37.7% prescription for physical therapy and 11.9% prescription for work absenteeism.ConclusionsBenchmarks for four electronic health record-extractable quality indicators have been established. They can be used for an electronic audit & feedback tool in primary practice in Flanders or other quality improvement initiatives.

Long-term opioid therapy in older adults: Incidence and risk factors related to patient characteristics and initial opioid dispensed.

The clinical benefits of long-term opioid therapy (LTOT) are not clearly known; however, LTOT is associated with various adverse outcomes. This study aimed to estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years. This was a retrospective cohort study using Medicare claims data. Opioid-naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having > 60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT. Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age > 85 years (adjusted odds ratio 1.13 [95% confidence interval 1.05-1.21]); > 5 comorbidities (1.55 [1.45-1.65]); and history of drug use disorder (1.53 [1.35-1.74]), alcohol use disorder (1.38 [1.23-1.54]), tobacco use disorder (1.31 [1.23-1.40]), and opioid use disorder (2.00 [1.69-2.37]). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (1.72 [1.21-2.44]) and concomitant use of benzodiazepines (1.16 [1.08-1.25]), gabapentinoids (1.57 [1.47-1.67]), and prescription nonsteroidal anti-inflammatory drugs (1.24 [1.17-1.31]). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT than days' supply of 1-3 days. Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days' supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to senior patients.

Non-steroid anti-inflammatory drugs: recommendations and precautions for safe use in a multidisciplinary surgical department

Aim of the study. Conducting a safety analysis of the use of non-steroidal anti-inflammatory drugs in order to develop informed recommendations and precautions for medical practice.Materials and methods. A retrospective analysis of inpatient medical records of 250 patients in the multidisciplinary surgery department was conducted for the period from December 2023 to February 2024.Results and discussion. Based on the results of the analysis of inpatient medical records, such criteria as the presence of indications for the prescription of non-steroidal anti-inflammatory drugs (according to the diagnosis, clinical pain syndrome and according to pain assessment scales), compliance of the choice of non-steroidal anti-inflammatory drugs with national protocols/international recommendations, compliance with age, the patient's physiological/ pathological condition and allergy history for the prescription of non-steroidal anti-inflammatory drugs were 100%. The indicator for compliance of a single therapeutic dose, route of administration, frequency, duration and an appropriate diluent of non-steroidal anti-inflammatory drugs with instructions for use was 86%, where medication errors were mainly made in the frequency of use of drugs. The percentage of polypharmacy was 20%. The criterion for assessing drug-drug interactions between drugs taken by patients showed that interactions of high clinical significance (major) were 8%, while those of moderate clinical significance (moderate) were 40%.Conclusions. Nonsteroidal anti-inflammatory drugs are convenient and affordable drugs that are widely used in the treatment of diseases of various organs and systems. Therefore, to ensure the rational and safe use of drugs in this group, it is necessary to introduce effective recommendations and precautions:1. Timely completion of pain assessment scales and diary records in the Damumed medical information system;2. Development in the Damumed medical information system of divisions of appointments into planned and pro re nata (as necessary), introduction into the system of accurately recording the time of execution of doctors’ prescriptions by nursing staff for strict compliance with the intervals between doses of non-steroidal anti-inflammatory drugs allowed by the instructions.3. Introduction into the practice of doctors the use of tools to combat polypharmacy in patients ≥65 years old: Beers criteria;4. Conducting educational activities, covering both medical personnel and patients, in order to increase the level of registration of unwanted adverse reactions.

Physicians’ attitudes toward gastroprotective strategies for nonsteroidal anti-inflammatory drug prescription

Introduction There is a paucity of information regarding providers’ attitudes toward gastric-protective strategies with concurrent use of nonsteroidal anti-inflammatory drugs (NSAIDs). We aimed to assess gastric-protective strategies used upon prescribing NSAIDs and providers’ awareness of societal guidelines for preventing NSAID-induced gastric complications. Methods A standardized 10-item questionnaire was sent to all orthopedic providers in North Carolina and South Carolina. The survey design and refinement were based on a literature review, item generation, and small and large focus group discussions. Results Forty-two orthopedists responded to the survey (response rate 16%). The most frequently used NSAIDs were meloxicam (79%), naproxen (69%), and ibuprofen (64%). NSAIDs were most commonly prescribed on an as-needed basis (52%), followed by <3 months (43%). The most common indications were degenerative arthritis (95%) and herniated disk (45%). Gastrointestinal adverse effects of NSAIDs were managed by discontinuing NSAID therapy (73%) or switching to a cyclooxygenase-2 (COX-2) inhibitor (40%). A small proportion were managed by referring to another physician (36%). Some clinicians prescribed gastric prophylaxis for patients at high risk for NSAID-induced gastric complications (24%). The academic setting was significantly associated with gastric prophylaxis and frequent assessment for NSAID-induced gastric adverse events. Providers with >20 years of experience showed similar trends. In low-risk patients, compliance with gastroprotective prophylaxis prescription was low (5%). Most providers were unaware of the societal guidelines for NSAID-induced gastric complications or the preventive strategies. Conclusion Prescription of gastric-protective medications with concurrent NSAID therapy is relatively low among orthopedists. Academic setting and higher years of experience showed a significant trend toward more gastric-protective medication prescription, COX-2 inhibitor use, and frequent assessments for gastric adverse events when prescribing NSAID therapy. Provider education on the latest societal guidelines and computer-based alerts can increase compliance and assessment for NSAID-induced gastric complications and preventive strategies.

Prescription trends in Japanese advanced Parkinson's disease patients with non-motor symptoms: J-FIRST.

Non-motor symptoms (NMS) are important factors when selecting treatments for patients with advanced Parkinson's disease (PD). We sought to elucidate the prescribing practices for advanced PD patients with NMS in Japanese clinical practice. We examined the prescription rates and doses of anti-PD drugs, and the use of non-steroidal anti-inflammatory drugs (NSAIDs) in post hoc analyses of a 52-week observational study of 996 PD patients with wearing-off on levodopa-containing therapy and ≥1 NMS. Dopamine agonists were the most frequently prescribed drugs combined with levodopa-containing drugs, followed by entacapone, zonisamide, istradefylline, selegiline, and amantadine. The daily dose of levodopa-containing drugs, rotigotine, entacapone, istradefylline, and droxidopa, and the levodopa-equivalent dose increased during the observation period. In a subgroup analysis of patients stratified by NMS status (improved/unchanged/deteriorated), the deteriorated group had higher prescription rates of entacapone and istradefylline, whereas the improved group had higher prescription rates of NSAIDs and zonisamide at Week 52. Prescriptions varied by geographical region for anti-PD drugs and by NMS status for NSAIDs. There were significant changes in the prescriptions and dosing of selected anti-PD drugs, especially newer drugs. Anti-PD drug and NSAID prescriptions also varied by changes in NMS status and geographic region.

Thoracalgia: diagnostic and treatment algorithms

Treatment of patients with chest pain (thoracalgia) is a current medical issue. The most common cause of thoracalgia is a benign musculoskeletal pain such as intercostal myofascial pain, facet syndrome and osteoarthritis of the sternocostal joints. However, chest pain can also be caused by life-threatening conditions that require emergent medical care. The article presents the clinical symptoms and treatment approaches for various chest pain syndromes and the principles of differential diagnosis of cardiac pain. The basis of effective treatment is a comprehensive approach that includes patient education about the benign nature of the condition, kinesiotherapy and cognitive behavioral therapy for chronic pain. Among the drug methods, the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) is the most important. Nimesulide is an NSAID with an optimal profile of efficacy and safety. The example of a clinical case shows the heterogeneity of pain syndromes in patients with chest pain, whose timely diagnosis and complex treatment can prevent pain chronification and improve patients' quality of life.

Appropriate Prescription of Non-Steroidal Anti-Inflammatory Drugs in Geriatric Patients—A Systematic Review

The elderly population is growing worldwide. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed, but their adverse events can pose significant risks. Different NSAID molecules can exhibit varying risk profiles. This study aims to evaluate the cardiovascular, gastrointestinal, and renal safety profiles of ibuprofen, naproxen, acemetacin, diclofenac, celecoxib, and etoricoxib in elderly patients. A comprehensive literature search was conducted in PubMed and Cochrane Library. For the selection of articles, we used Medical Subject Headings (MeSH) terms “aged” sequentially and together with “ibuprofen”, “diclofenac”, “naproxen”, “acemetacin”, “celecoxib”, and “etoricoxib”. To assess the quality and interest of the articles, four independent reviewers screened titles and abstracts to identify potentially eligible studies. Strength of Recommendation Taxonomy (SORT) was used to rate the quality of individual studies and to establish recommendation strengths (RS). From 2086 articles identified, 39 studies met the inclusion criteria. Twenty studies analyzed cardiovascular safety, fourteen gastrointestinal safety, and four renal safety. When CV risk is the main concern celecoxib or naproxen are a good first choice (RS B). In high GI risk addition of PPI to naproxen or celecoxib use should be recommended (RS A). When renal function is on focus, celecoxib remains as first line of therapy (RS A). Diclofenac in the geriatric population should be avoided (RS B). Celecoxib is a good choice for elderly patients for whom it is difficult to direct pain treatment based on a single known risk factor (RS B).

Nonsteroidal Anti-inflammatory Drug (NSAID) Prescriptions in Living Kidney Donors

Nonsteroidal Anti-inflammatory Drug (NSAID) Prescriptions in Living Kidney Donors

Nonsteroidal anti-inflammatory drug (NSAID) prescribing after gastrojejunostomy: A preventable cause of morbidity

ObjectiveStudy findings showing an association between nonsteroidal anti-inflammatory drug use and marginal ulcer, a significant cause of morbidity after gastrojejunostomy, have been inconsistent. This study aimed to evaluate this relationship in large cohort. MethodsThis retrospective cohort included adult patients with a history of gastrojejunostomy documented between 2004 and 2023. The electronic medical record was queried for nonsteroidal anti-inflammatory drug prescriptions, marginal ulcer diagnosis, and comorbidities. Multivariable logistic regression was performed to assess the association between marginal ulcer and nonsteroidal anti-inflammatory drug exposures, controlling for smoking, Helicobacter pylori history, acid-suppressing therapy, diabetes, age, and sex. ResultsDuring the study period, 6,888 patients with a history of gastrojejunostomy were identified, of whom 45.2% (n = 3,115) of patients were exposed to an nonsteroidal anti-inflammatory drug and 10.12% (n = 697) developed a marginal ulcer. On multivariable analysis, the risk of marginal ulcer was found to be dose-dependent, with increasing odds of marginal ulcer with an increasing number of nonsteroidal anti-inflammatory drug exposures from odds ratio 1.67 (95% confidence interval, 1.37–2.02) with 1–2 nonsteroidal anti-inflammatory drug exposures to odds ratio 2.42 (95% confidence interval, 1.79–3.24) with >8 nonsteroidal anti-inflammatory drug exposures. Acid-suppressing therapy was found to be protective (odds ratio, 0.61; 95% confidence interval, 0.52–0.73). Over the last decade, the number of nonsteroidal anti-inflammatory drugs prescribed to patients with gastrojejunostomy has significantly increased from 15.87 prescriptions per 1,000 patients per year to 531.02 per 1,000 patients per year (R2 = 0.91, P < .001). ConclusionMarginal ulcer after gastrojejunostomy is associated with nonsteroidal anti-inflammatory drug prescriptions in a dose-dependent manner. Although acid-suppressing therapy appears protective for marginal ulcer, quality improvement efforts should focus on diminishing nonsteroidal anti-inflammatory drug prescribing in this population.

Assessing the patterns of prescribing of Non-Steroidal Anti-Inflammatory drugs in one of the District hospitals in Jordan with focus on clinical safety and monitoring aspects

Assessing the patterns of prescribing of Non-Steroidal Anti-Inflammatory drugs in one of the District hospitals in Jordan with focus on clinical safety and monitoring aspects

Steroidal Anti-Inflammatory Drugs for Oral Surgery: A Systematic Review and Meta-Analysis.

The aim of the present study was to investigate if there are differences in mitigation acute pain following oral surgery procedures within a hospital setting and regarding various medication regimens. A systematic literature search was performed between the years 2013 and 2023, including the databases PUBMED, Cochrane and Scopus, to identify the clinical trials investigating the prescription of non-steroidal (NSAID's) anti-inflammatory drugs before or after an oral surgery. A meta-analysis with meta-regression model was employed on the primary and secondary outcomes, such as pain, swelling and trismus. Thirty-six articles were included, 6 of them being retrospective and 30 prospective, with a higher proportion of women than men, at a ratio of 1.34:1 and an average age of 31.9 years. Drugs with medium duration of action demonstrated lower values for pain and swelling. Regarding these parameters, pain and swelling, propionic acid derivatives and acetic acid derivatives exhibited lower values respectively. The quality of evidence was low to very low- certainty. The meta-analysis suggests that postoperative pain, swelling and trismus following oral surgery management may be effectively treated with the following drugs: NSAID medium-duration action drugs; propionic acid derivatives for lower pain levels and acetic acid derivatives for lower swelling measures; and Ibuprofen 400mg every 8h for 3 days or less. Anti-inflammatory and analgesic drugs are prescribed to prevent or treat dental pain. Ibuprofen 400mg was the most prescribed drug after or before an oral surgery procedure. However, the evidence is indirect and needs to be interpreted with caution.

Changes in analgesic prescriptions in Dutch general practice

Background Increases in opioid prescriptions have been described; however, recent trends and prescribing patterns of analgesics in Dutch general practice are largely unknown. Objective To investigate recent changes in the number of analgesic prescriptions, and the indications for prescribing strong opioids. Furthermore, we aim to identify risk factors for chronic opioid use in Dutch general practice. Design and setting A retrospective cohort study from 1 July 2013 to 31 June 2022, using a primary care practice based research network. Subjects Patients with ≥1 prescription for analgesics during the study period were included. Main outcome measure Changes in the number of prescriptions for paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and opioids in Dutch general practice during the 9-year study period. Moreover, we analyzed indications for prescribing strong opioids by the general practitioner (GP). Results A total of 18,433 analgesic users were identified. Over time, prescriptions for paracetamol, NSAIDs and weak opioids decreased, while the number of strong opioid prescriptions increased. General practitioners prescribed more strong opioids for non-malignant pain, whereas prescriptions for malignant pain remained stable over time. Risk factors for chronic opioid use (≥90 days) included older age, lower educational level, smoking status and having a history of a musculoskeletal or psychological disorder, a malignancy or sexual, physical or psychological abuse. Conclusions Considering the increase in strong opioid prescriptions for benign conditions, GPs need to be vigilant for patients who are at risk for chronic use. Regular monitoring and awareness for psychosocial factors in treatment of chronic pain may be key in preventing harms associated with persistent opioid use.

Prescription of non-steroidal anti-inflammatory and antirheumatic drugs in outpatient hypertensive patients.

It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

Frequent use of prescription NSAIDs among people with knee or hip osteoarthritis despite contraindications to or precautions with NSAIDs

ObjectiveTo describe use of Non-steroidal Anti-inflammatory Drugs (NSAID), opioid, and physiotherapy (PT) among persons with newly diagnosed knee or hip osteoarthritis (OA) with and without NSAID contraindications or precautions. DesignWe used population-based register data to identify adults aged ≥35 as of January 1, 2014 residing in Skåne region (Sweden) between 2004-2013, without a previous knee or hip OA diagnosis. Among this cohort, we identified people with incident knee or hip OA diagnosis between 2014-2018, and presence of contraindications to or precautions for oral NSAIDs at the time of OA diagnosis. We estimated the risk of: 1) regular oral NSAID use; 2) regular opioid use; 3) PT during the first year after diagnosis among those with vs. without contraindications or precautions using confounder-adjusted logistic regression with standardization. ResultsWe identified 35,173 persons with newly diagnosed OA, of whom 3,257 and 8,351 had ≥1 contraindication to oral NSAIDs and ≥1 precaution, respectively. Overall, 27% of individuals used oral NSAIDs (with or without opioids or PT), 10% used opioids, and 57% attended PT. Among patients with contraindications, 21% used oral NSAIDs compared to 31% without (absolute adjusted difference -0.06 (95% CIs: -0.08, -0.05)), 53% vs 59% used PT (adjusted difference -0.03 (-0.05, -0.01)), while 14% vs 8% had prescribed dispensed opioids (adjusted difference 0.02 (0.01, 0.03)). Similar results were observed for those with precautions. ConclusionsWe highlight the need for safer treatment options. People with OA and contraindications/precautions to NSAIDs have higher risk of opioid use, slightly lower risk of PT use, and continue to be prescribed NSAIDs. Availability of data and materialsAll the data used in the study are available upon request to the appropriate Swedish National authorities.

Identifying Vulnerabilities to NSAID Adverse Events in the U.S. Population: An Analysis of Preexisting Conditions and Sex.

Purpose: In 2005, the Food and Drug Administration (FDA) issued a decision memorandum regarding nonsteroidal anti-inflammatory drugs (NSAIDs). The memorandum recommended the withdrawal of certain NSAIDs due to potential cardiovascular adverse effects. It highlighted the issue of cardiovascular risk associated with NSAIDs as a class. The NSAID medication guide includes a wide range of adverse drug reactions (ADRs), such as increased blood pressure, liver failure, allergic reactions, heart attack, and intestinal bleeding. Although both sexes have an increased risk of ADRs with NSAID use, females have a greater risk than males due to differences in pharmacodynamics and higher medication concentrations (mg/kg). In particular, females with high blood pressure, coronary heart, kidney, and liver disease are at an additional risk of harm from NSAID ADRs. This study quantifies sex-specific differences and other factors associated with prescription NSAID use. Method: The data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES), a complex survey conducted by the Centers for Disease Control and Prevention (CDC) in two-year cycles. A survey-weighted logistic regression model was utilized to investigate potential sex differences with prescription NSAIDs in the context of other factors, including kidney disease, hypertension, liver disease, insurance status, coronary heart disease, and age, within the 2011-2018 NHANES survey data. Results: Females reported a slightly higher percentage of high blood pressure and kidney disease than males, while males reported a slightly higher percentage of coronary heart and liver disease than females. Last, the model indicated that females were 58% more likely to have used a prescription NSAID than males. Conclusion: The results confirm that women and people with medical conditions, who would potentially suffer greater harm from NSAID ADRs, are more likely to use a prescription NSAID than individuals without these conditions.

Epidemiology of Agranulocytosis and other Medically Important Adverse Reactions in Mexican Population Associated with Metamizole

Background/Aim: Metamizole, a non-opioid analgesic, has been used for a long time, but studies linking it to potentially life-threatening adverse drug reactions, such as agranulocytosis, have raised safety concerns. However, the reported incidence of these events is widely variable. This study aims to shed light on the pharmacological safety of metamizole in Mexico, with a particular focus on medically important suspected adverse drug reactions, especially agranulocytosis. Materials and Methods: We extracted data on cases of medically important suspected adverse drug reactions (SADRs) and prescriptions for metamizole and non-steroidal anti-inflammatory drugs (NSAIDs) from the database of medical emergency records within the Mexican Ministry of Health, covering the period from 2014 to 2022. We calculated frequencies, proportions, and reported odds ratios for medically important SADRs and agranulocytosis. Results: Metamizole ranked as the third most frequently prescribed non-opioid analgesic and accounted for 13.7% of medically important SADRs potentially linked to drugs of its class. Among consultations involving metamizole prescriptions, the most common SADRs included unspecified kidney and ureter disorders, toxic liver disease, other specified forms of angina pectoris, aplastic anemia, and agranulocytosis, the latter being recorded in just 0.002% of these consultations. The reported odds ratio for agranulocytosis associated with metamizole prescription compared to NSAIDs was 0.3 (95% CI 0.20 - 0.45). Conclusions: The data source we analyzed provides limited evidence regarding the safety profile of metamizole, as it did not allow us to establish a causal relationship between drug prescription and SADRs. Our findings suggest that metamizole is widely used in Mexico and that adverse reactions associated with its prescription may occur less frequently than those linked to NSAIDs. Additionally, metamizole-induced agranulocytosis appears to be rare in the Mexican context.

Excessive Self-Medication with Prescription NSAIDs: A Cross-Sectional Study in Kosovo.

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain, fever, and inflammation. Although most are usually classified as prescription-only medicines, in many countries they are frequently purchased for self-medication purposes. This study explores NSAID-usage patterns in Kosovo, aiming for a safer and more effective medicinal use. The study employed a dual approach to collect data. First, NSAID sales were analyzed in a convenience sample of ten community pharmacies across diverse regions in Kosovo in 2023. Second, data on NSAID-usage patterns and patient awareness were systematically gathered from 410 patients during routine pharmacist-patient interactions. The four most commonly purchased NSAIDs according to sales analysis were diclofenac (33.1%), ketoprofen (27.6%), ibuprofen (17.0%) and nimesulide (12.7%). A significant 74.8% of NSAIDs were bought without prescriptions, particularly among younger adults (20-39 years), who accounted for 82.8% of such purchases. The predominant reason for NSAID use was headache (43.8%). Although many of the patients suffered from occasional (33.7%) or frequent (12.6%) stomachaches and took acid-lowering medicines, the majority (85.9%) could not recall any NSAID adverse reactions. This study exposes widespread self-medication and a significant lack of awareness regarding potential risks of NSAIDs, particularly among young adults. To address these issues, it is critical to improve dispensing practices through increased pharmacist awareness and stricter law enforcement.

Massage Therapy Utilization in the Military Health System.

Massage therapy is an evidence-based approach for pain management. Information regarding its utilization in the Military Health System (MHS) is lacking. The goal of this study is to evaluate massage therapy utilization patterns across the MHS to include who receives (patient characteristics and diagnoses) and provides (e.g., massage therapists) massage therapy and where (e.g., clinic type). Medical record data of adult TRICARE Prime enrollees receiving outpatient massage therapy (Current Procedural Terminology codes: 97124 and 97140) from June 1, 2021, to May 31, 2023, were extracted from the MHS Data Repository. After identifying the index massage therapy visit, records for 6 months pre- and post-index were included. Descriptive statistics described massage therapy utilization patterns overall. Bivariate analysis compared patients who received massage therapy from massage therapists versus nonmassage therapist clinicians. Of patients who received massage therapy (n = 179,215), the median number of visits was 2 (interquartile range 1 to 4), the median age was 32 years (interquartile range 25 to 40), they were mostly assigned male (72%), White (53%), Senior Enlisted (51%), with a musculoskeletal diagnosis (90%), and recent non-steroidal anti-inflammatory drug (NSAID) prescription (58%). Massage therapy was primarily delivered by physical therapists (49%) in physical therapy clinics (74%). Massage therapists provided 0.2% of massage therapy. Patients who received massage therapy from massage therapists versus nonmassage therapists significantly varied across several patient and care characteristics. While massage therapy codes are documented frequently, massage therapists do not commonly provide massage therapy relative to nonmassage therapist providers. Access to massage therapists may be stymied by both lack of massage therapists and need for tertiary pain management referrals to access massage therapist-delivered care. Future research will leverage a health equity framework to (1) evaluate accessibility to massage therapy provided by massage therapists and (2) evaluate real-world evidence of massage therapy effectiveness.