>Users:   login   |  register       > email     > people    


NSAIDs. The Essentials of Prescribing for Pain
By Jeffrey E. Keller MD
Published: 12/16/2019

Pharmacy After many years of reviewing prescribing practices of physicians both within correctional systems and outside of the walls, here is something that I strongly believe:

Non-Steroidal Anti-inflammatory Drugs (NSAIDS) just may be THE most misunderstood and overprescribed drugs in clinical medicine. It appears to me that, in general, we practitioners overestimate the benefit NSAIDS give. We underestimate the risks NSAIDS carry. And we prescribe NSAIDS in ways that are not evidence based and not in our patients’ best interest.

NSAIDS have two basic functions: they are used as general pain relievers, and they reduce inflammation. These are two separate properties, utilizing separate chemical receptors. NSAIDS are prescribed as pain relievers much more often than for their anti-inflammatory effect, so I’d like to begin there. Take, for example, a patient who complains of a headache. I’m not talking about a vascular headache, I mean the standard, ordinary headache that everyone gets now and again. In order to relieve this headache, should this patient take ibuprofen 400mg? or 800mg? Would a prescription NSAID, like meloxicam or an injectable NSAID, like ketorolac, work any better? Is there any benefit of NSAIDs in this case compared to acetaminophen?

The single most important fact to understand about NSAID pain relieving properties is this: the analgesic effect of NSAIDs “maxes out” at a much lower dose than the anti-inflammatory effects. As an example, the pain-relieving properties of ibuprofen max out at a dose of around 400mg. Patients get no increased analgesic effect from prescriptions of 600mg or 800mg of ibuprofen. This principle applies to all NSAIDs. There is no analgesic benefit from Naproxen 500mg over Naproxen 250mg.

However, the potential for NSAID complications increases both with larger doses and increased length of time that patients take NSAIDs. So why do we prescribe large doses of ibuprofen when patients cannot benefit and can only be harmed from such a dose? One possible reason could be the myth that “more is better.” If a little is good, then more has got to be even better! In the case of NSAIDs, however, this is not the case. If a bigger dose cannot help (because it gives no more relief from pain) but could harm the patient (by increasing the risk of adverse effects), then more is definitely not better.

The next essential NSAID fact is this: NSAIDS are equivalent as far as their analgesic effects. No one NSAID has ever been shown to be superior to another. They differ in their tendency to cause complications, but not in their ability to reduce pain. Despite the marketing, Celebrex is no more effective than ibuprofen. Toradol (ketorolac) is no more effective than any other NSAID. And in fact, NSAIDs are not superior to acetaminophen when used for pain relief in any clinically significant way. This is probably because both NSAIDs and acetaminophen act on the same biochemical receptor to reduce pain—though this receptor has not yet been identified.

The final essential NSAID fact when used as pain relievers is this: The more a patient takes them, the less effective they are. Patients need to understand this. If you take Naproxen (for example) every day, twice a day, it will be less effective when you do have a headache than if you only take it once in a while. NSAIDs prescribed for pain should be prn prescriptions. This is true especially for patients with chronic pain. The guy with a bad knee that always hurts should not take scheduled doses of NSAIDs.

More on this this—plus NSAIDs used for their anti-inflammatory properties—in the next JailMedicine post. In the meantime:
  1. The analgesic effects of NSAIDs maxes out at a low dose. There is no benefit to giving large doses for pain. Don’t do it!
  2. All NSAIDs are equivalent as pain relievers. Use the convenient (and least expensive) one.
  3. NSAIDs used as pain relievers should be prescribed PRN.
As usual, what I have posted here is my opinion, based on my own research and experience. Feel free to disagree! I could be wrong. If you do disagree, say why in the comments.

Corrections.com author, Jeffrey E. Keller is a Board Certified Emergency Physician with 25 years of practice experience before moving full time into the practice of Correctional Medicine. He is the Medical Director of Badger Medical, which provides medical care to inmates in several jails throughout Idaho. He is also the author of the "Jail Medicine" blog

Other articles by Keller


Comments:

  1. Adam5454 on 03/30/2020:

    Worldfree4u ---- Many people around the world like to watch the latest movies and web series. There are a no. of options to choose from when it comes to watching movies and web series. There is a website that provides everything for free and its name in WorldFree4u.

  2. Adam5454 on 03/25/2020:

    Ayublogsystem is a platform that provides you with the latest information related to entertainment, fitness, health, sports, and politics. We also provide information related to websites like movierulz2 and katmoviehd.

  3. Adam5454 on 03/25/2020:

    Telegram

  4. abhisheksunny3030 on 03/14/2020:

    Movierulz is a movie website. Tricksnhub is a news website covering different topics from around the world.

  5. keatonjefferson on 03/12/2020:

    Thanks a lot for sharing these essentials for pain with us. I will tell my mates working at Source: https://www.weednews.co/best-cbd-oil/ about this so that they can include this in their papers. It will benefit them a lot.

  6. shouabalikhatri on 01/28/2020:

    Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info. 카지노사이트

  7. lewis on 01/23/2020:

    TelegraphStar.com aims at serving the viewers with detailed and dynamic content. We publish the news which matters and can affect your lifestyle. 10th result

  8. amnaseo on 01/22/2020:

    This is what commonly happens to the newbies in the business industry who do not know how to effectively market their product or service or service.techedesign.com

  9. leahmelda on 01/21/2020:

    Students who seek Criminology Writing Services Online from the custom writing company are guaranteed of getting good grades for their Criminology Custom Writing Help and Criminology Coursework Writing Services that are free from grammatical errors.

  10. leahmelda on 01/20/2020:

    Students who seek Criminology Writing Services Online from the custom writing company are guaranteed of getting good grades for their Criminology Custom Writing Help and Criminology Coursework Writing Services that are free from grammatical errors.

  11. leahmelda on 01/20/2020:

    Companies offering Computer Science Writing Services should help students perform well by delivering papers prior to deadline as early delivery of Custom Computer Science Research Papers and Custom Written Computer Science Term Papers is very important because it results in good performance of learners.

  12. leahmelda on 01/20/2020:

    Agriculture Students always find out the Best Agriculture Writing Services since its very difficult to complete Custom Agriculture Research Paper and Agriculture Custom Term Paper.

  13. ajay maurya on 01/19/2020:

    I really appreciate this wonderful post that you have provided for us. I assure this would be beneficial for most of the people. Thanks for sharing the information keep updating, looking forward to more posts  click here

  14. OnlineCasino on 01/11/2020:

    토토사이트추천 토토사이트

  15. Anika on 01/07/2020:

    Russian escorts in Faridabad call girls in Faridabad Russian Escorts in Faridabad call girls in Near me VIP Escort service in Faridabad Escort service in Faridabad

  16. Anika on 01/07/2020:

    Escorts In Mumbai Mumbai Call Girls Call Girls In Mumbai

  17. Anika on 01/07/2020:

    Mumbai call girls call girls in Faridabad call girls in Guwahati

  18. Anika on 01/07/2020:

    Guwahati Escorts Service Escorts in Guwahati Female Escorts in Guwahati call girls in Paltan Bazar Independent call girls In Guwahati Sexy girls Call girls in Guwahati

  19. Anika on 01/07/2020:

    Guwahati Escorts Service Escorts in Guwahati Female Escorts in Guwahati call girls in Paltan Bazar Independent call girls In Guwahati Sexy girls Call girls in Guwahati

  20. JustinJacob on 12/30/2019:

    Nonsteroidal anti-inflammatory drugs are the drugs used for reducing pain, lowering fever and preventing blood clots. A higher dose of this is used for decreasing inflammation. Major Uses of Cannabidiol A large amount of intake of this drug sometimes causes heart attacks or other kidney-related issues.

  21. zaiyamariya on 12/26/2019:

    The article here shares views on NSAIDs. Many of the prescribing practices of physicians are not known about the consequences of some drugs that they are prescribing for the patients. Hostsailor the article clearly explains the impact and the usage of the NSAID.

  22. leonamargret on 12/26/2019:

    NSAID 's are the anti-inflammatory pain relievers which are given mainly for arthritis. Hostsailor In fact, it is more than a pain reliever and also can be used for some of the other diseases. This post is so much useful for those who are not aware of this.

  23. tekrysbyuis on 12/26/2019:

    Fildena Professional Buy Fildena Professional White 100 MG used to cure erectile dysfunction for Men's with 0% Side Effects. Check side effects, 100% verified buyers reviews https://www.flatmeds.com/product/fildena-professional/

  24. leonamargret on 12/26/2019:

    NICE

  25. shouabalikhatri on 12/25/2019:

    What a fantabulous post this has been. Never seen this kind of useful post. I am grateful to you and expect more number of posts like these. Thank you very much. Best home security camera system

  26. Harshika on 12/25/2019:

    Quantity Surveying is one of the best-known professions in the construction industry

  27. Harshika on 12/24/2019:

    Now a days business management is one of a famouse course and most of students have follow the HND Business Management

  28. Kaitlyn on 12/24/2019:

    Here they have well explained about the NSAIDs. They are discussing both its pros and cons in this post clothing manufacturers usa. I think it is really useful for those who have not much idea about it. Thanks a lot for sharing this knowledge.

  29. Roger Fox on 12/22/2019:

    Your internet site is really indifferent and that is a pleasing challenging article. gifts

  30. Harshika on 12/20/2019:

    Become an MCIOB then enjoy your raised status and salary for get this opportunity you can Follow CMP Course

  31. xavier kingston on 12/19/2019:

    Follow UP with MCIOB courses to upgrade your chartered membership

  32. Stefan0 on 12/18/2019:

    Soluzioni CodyCross can be found at our site. Thanks for visiting


Login to let us know what you think

User Name:   

Password:       


Forgot password?





correctsource logo




Use of this web site constitutes acceptance of The Corrections Connection User Agreement
The Corrections Connection ©. Copyright 1996 - 2024 © . All Rights Reserved | 15 Mill Wharf Plaza Scituate Mass. 02066 (617) 471 4445 Fax: (617) 608 9015