Nonsteroidal anti-inflammatory drugs (NSAIDs) are a group of drugs that are used to treat a variety of pains. There are many NSAIDs on the market.
- Which one should we choose? Which one should we use? What is our answer to our patients who come with the question “If my neighbor used this drug, will it benefit me too?” How do we answer the question “Why is this drug not working for me now, when it used to work well before?
- It is difficult to predict the personal response to these drugs. It may be considered to continue with the drug that was effective before, or if the drug is reported to be ineffective, it may be replaced with a drug containing a different active ingredient.
- Are topical forms, that is, forms applied to the skin, effective?
- Studies have shown that topical forms are equally effective as oral intake in back pain and osteoarthritis. Moreover, topical forms are safer because they have fewer side effects. However, in many of our patients, there is a problem of compliance with topical forms in regular use in clinical practice, and the use is stopped.
- What dose should these drugs be used in?
- The lower the dose, the safer the use. If the initial dose is not sufficient, it is considered to increase the dose of the drug used to the maximum or to switch to a different NSAID drug by stopping the drug used but ineffective.
- Are two different NSAIDs used together? Can a person whose pain does not go away take another NSAID 30 minutes after taking the first drug?
- No, this use is not recommended. This type of use is not recommended because it can lead to more drug side effects. If the pain does not go away, he should do local applications at home, if the pain still persists, he should consult a doctor, and when he consults a doctor, he should mention the drugs he has used before.
- What are the side effects of NSAIDs?
- It has side effects on many systems such as cardiac, gastrointestinal, renal and liver toxicity.
- Especially allergic reactions, stomach bleeding, heart problems, hypertension and development of kidney failure should be kept in mind.
What Can Be Done To Prevent Toxicity In NSAID Use?
- It is important to question the patient’s additional diseases and other medications.
- Is there a history of gastrointestinal, cardiac, or cranial events?
- A history of gastrointestinal events (ulcer, bleeding history) increases the gastrointestinal risk by 4-5 times.
- The risk increases by 5-6 times over the age of 60
- The risk increases by 4-5 times when used at high doses (more than twice the normal amount)
- The risk increases by 4-5 times when used with corticosteroids
- The risk increases by 10-15 times when used with anticoagulants
- If pylori is present, the risk increases, and use is not recommended.
- In people who cannot avoid NSAID use, NSAIDs should be used at the lowest possible dose and duration, and if necessary, combined with a stomach protectant.
- Avoid unnecessary NSAID use. If possible, use acetaminophen.
- Who should be considered for prophylactic or protective treatment for the stomach?
- Patients who develop ulcers due to NSAIDs, but need to take chronic daily NSAIDs
- Patients over the age of 60
- Patients with a history of peptic ulcer disease or complications such as gastrointestinal bleeding
- Patients taking concomitant steroids or anticoagulants, should be considered in patients with significant comorbidities.
- What are the prophylactic treatments that reduce the risk of gastric and duodenal ulcers associated with NSAIDs?
- Misoprostol 100-200 mcg orally 4 times/day
- Omeprazole 20-40 mg orally daily
- Lansoprazole 15-30 mg orally daily, etc…
- In rectal (rectal) use, side effects are less than in oral administration.
- In oral administration, it is recommended to drink plenty of water and not lie down for 15-30 minutes after taking it.
- The analgesic effect starts even at low doses, but the anti-inflammatory effect should be increased to the maximum of the dose range.
- When taken with food, absorption is delayed, but gastrointestinal side effects are reduced.
- Appropriate doses for the elderly and children should be known.
- If necessary in pregnant women, short-lived, non-active metabolites should be preferred.
In conclusion, this drug group is one of the drugs that I wish we never had to use. However, we have to add these drugs to the treatment in many cases. The worst thing is that my patients are taking similar drugs one after the other unconsciously because their pain is too much.
Every medicine has side effects, many of which are listed in the package leaflet and which patients can read. Medicines should be used according to the benefit-benefit ratio.
Many people who experience sudden severe pain want the pain to stop as soon as possible with medication. Unfortunately, there are even patients / relatives who threaten the doctor because the pain does not stop.
However, in some cases, stopping the pain may prevent the diagnosis, the findings may be masked with the medication taken, or a second condition may develop with the side effect of the medication taken and a more serious condition than the original disease may have to be dealt with.
NSAIDs are among the drugs we frequently use in the treatment of pain related to my speciality. In clinical practice, patients need to make sure that they use the correct dose of medication and that they do not use two NSAIDs together when using several drugs. Muscle relaxants and NSAIDs can be used at the same time.
However, nowadays there are drugs that contain muscle relaxants and painkillers together and the patient may not be aware that they are taking them together. For this reason, it is important that patients carry the medications they are taking with them to the doctor and ask which medication and at what dose until they are clear.
It is important to stop the medication as soon as possible. However, sometimes longer use may be required for prolonged severe pain. In this case, gastroprotective measures may need to be taken to reduce the side effects of the medication, and blood values, liver and kidney function may need to be evaluated by checking blood tests intermittently.
The aim of gastroprotective measures is to prevent the development of a potentially fatal side effect such as gastric bleeding.
Stomach protectants are added to the treatment as long as NSAIDs are used; it should be discussed whether longer use is required. Stomach protectants can cause various problems in long-term use.
In order to reduce the use of NSAIDs in chronic pain, different drugs (such as antidepressants, gabapentinoids, opioids) may need to be added to the treatment. Of course, these drugs may have different side effects.
It is recommended that the patient be aware of the possibility of side effects and contact his/her doctor in case of complaints, discontinue the medication causing side effects and follow-up.
After the medication is prescribed, the effectiveness of the medication will be monitored and the side effects will be monitored by the patient’s self-monitoring. It is decided accordingly when to discontinue the medication. NSAIDs are not among the drugs recommended for continued use in diseases other than inflammatory rheumatic diseases. Long-term use of NSAIDs may be recommended in some inflammatory rheumatic diseases, but in this case, regular follow-up is recommended in terms of side effects.
One of the mistakes made in our society is to take painkillers and do all the work to be done that day, and to load the body of the person who suppresses the pain even more.
Ignoring the need for rest and care given by our body with pain, taking medication and continuing to rush by ignoring the pain may cause the existing problem to return with even more severity.
If it is necessary to take NSAIDs, the shortest possible duration and the lowest effective dose should be planned, and if the need for medication still persists despite a reasonable period of use, non-drug treatments (physiotherapy, injection therapies, surgical treatment, traditional complementary medicine practices, etc.) should be investigated.