NSAIDs: Striving for Judicious Use

NSAIDs: Striving for Judicious Use

Every winter when cold and flu season hits, millions of people take non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen to ease the aches and pains associated with being sick. In addition, about 23 million Americans use over-the-counter NSAIDs every day. There were also close to 98 million prescriptions for NSAIDs filled last year, making them one of the most commonly prescribed medication classes in the United States. Addressing AEs Like all medications, NSAIDs can cause adverse events (AEs), particularly when they are used inappropriately. Both selective and nonselective NSAIDs can cause significant and even life-threatening events, including gastrointestinal, renal, and cardiovascular AEs. It’s important to counsel patients about appropriate use of NSAIDs. The FDA recommends using NSAIDs at the lowest effective dose for the shortest period of time required to provide therapeutic effect. The incidence of NSAID-related AEs increases significantly with concurrent use of multiple NSAID products and higher doses and longer duration of use. Many patients knowingly use prescription and OTC NSAIDs at the same time, increasing their risk of AEs. However, many more likely do so unknowingly because they’re unfamiliar with the term NSAID and don’t know which products are NSAIDs. Many patients are also unaware that some cold and pain medications contain NSAIDs that are combined with antihistamines, decongestants, or other analgesics, which can lead to using multiple NSAID products at the same time. A lack of patient awareness about NSAIDs—combined with the availability of OTC NSAID products—complicates their appropriate use. Ensuring Proper Use There are several steps physicians can take to ensure appropriate NSAID use. A thorough medication review at each patient visit, including...

Examining Chronic Opioid Use in TKA

Consensus statements on the management of knee osteoarthritis have not thoroughly addressed the use of opioid medications in patients undergoing total knee arthroplasty (TKA). In order to reduce postoperative pain, most reports recommend that mild analgesics (eg, acetaminophen) be used initially after TKA, followed by NSAIDs and opioids. More recently, concerns have been raised about using opioids because of tolerance issues with these drugs as well as increased responses to pain. Other studies have suggested that opioids can worsen treatment outcomes. Opioid Dependence Worsens Outcomes In the November 2, 2011 Journal of Bone & Joint Surgery, my colleagues and I had a study published in which we compared the perioperative course, complication rates, and clinical outcomes of patients who underwent TKA and if they were treated with chronic preoperative oral opioid analgesics. We looked at 49 knees in patients who had regularly used opioids for pain control prior to TKA and compared them with patients who didn’t use these medications. According to our results, chronic opioid use prior to TKA made it much more difficult for patients to recover after their surgery. Patients who used opioids before their surgery had longer hospital stays, more postoperative pain, and higher complication rates than those who weren’t opioid dependent. They were also more likely to need additional procedures, require referrals for pain management, suffer from unexplained pain or stiffness, and have lower function and less motion in the replaced knee. The differences between patient groups in our study were even greater than we expected, and chronic opioid use was linked to poorer outcomes across the board. Seize Opportunities to Educate Patients About...