COX-2 inhibition and pain management: a review summary

Cyclooxygenase-2 selective inhibitors have long been regarded as potent anti-inflammatory drugs for the treatment of arthritis, osteoarthritis and dysmenorrhea. The reports of cardiovascular risk and the subsequent withdrawal of rofecoxib, and recently valdecoxib, has called the therapeutic potential of coxibs into question. Currently, according to the latest decisions of the US Food and Drug Administration and European Medicines Agency, the approval of valdecoxib has been refused for 1 year due to an increased rate of cardiovascular risks and serious skin reactions. There are restrictions concerning the use of all other coxibs. The short-time use of coxibs, however, in anti-inflammatory treatment and in perioperative settings may become important in the future. Exact insights into the processes of pain modulation explain the benefit of coxibs in reducing peripheral and central nociception, and their use in pre-emptive and multimodal pain management. In the future, coxibs could be established into a personalized therapy in patients with a low cardiovascular risk, but with increased risk of gastrointestinal complications.