The demographics of chronic pain management

Pain is the most common symptom for which patients seek care. The management of pain advanced considerably with the development of cyclooxygenase (COX)-2-specific inhibitors (coxibs). The clinical usefulness of nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) is often limited by the occurrence of adverse effects, such as gastric toxicity and bleeding complications, which have been attributed to the inhibition of COX-1. At the recommended dosage by targeting only COX-2, coxibs offer patients anti-inflammatory and analgesic relief with reduced gastrotoxicity compared with traditional NSAIDs. Individualization of therapy based on a careful assessment of risks versus benefits of different agents is an important consideration in pain management. This review summarizes clinical evidence of the comparable efficacy but improved tolerability of the coxibs compared with conventional NSAIDs. Important patient considerations and risk factors involved in the selection of appropriate analgesic/anti-inflammatory treatments are highlighted.