Safety of cyclooxygenase 2 inhibitors for rational management of acute and chronic pain Review article
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Abstract
There are many classifications of pain, including the division into acute and chronic pain. In addition to their duration, acute and chronic types of pain differ in numerous other respects; therefore, the choice of analgesics should rely on pharmacokinetic properties and safety profiles of drugs. Amongst non-steroidal anti-inflammatory drugs, preferential COX2 inhibitors are considered a good choice due to their effective analgesic, anti-inflammatory and antipyretic properties and lower risk of adverse side effects, gastrointestinal ones in particular. Nimesulide is a relatively safe preferential COX2 inhibitor used for management of various types of pain. Due to its quick effects, the drug is widely used to relieve acute pain. Considering possible complications, especially hepatotoxicity, the drug should be used for short-term therapy. In the majority of cases, nimesulide-induced hepatic disorders subside after its withdrawal. Meloxicam, another preferential COX2 inhibitor, is an effective analgesic and anti-inflammatory agent for long-term therapy of chronic pain, which is attributable to its pharmacological properties such as long half-life. The efficacy of meloxicam is comparable to that of non-selective COX2 inhibitors yet its safety profile is substantially better. In conclusion, while choosing a non-steroidal anti-inflammatory the drug properties should be adjusted to the type and duration of pain.
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