Nonsteroidal anti-inflammatory drugs and their risk: a story still in development

NSAIDs are anti-inflammatory, analgesic, and antipyretic agents, and they are typically used chronically to reduce pain, decrease stiffness, and improve function in patients with osteoarthritis, rheumatoid arthritis, and other forms of arthritis. Additionally, NSAIDs are also used for the more acute treatment of pain including headache, dysmenorrhea, and postoperative pain. However, NSAID use conveys potential significant adverse events that include gastrointestinal ulcers with consequential bleeding, perforation or obstruction, renal dysfunction and consequent renal failure, cardiovascular events, as well as the risk for death. Despite the many available forms of NSAIDs, including injectable as well as topical, oral dosing is the most common route, usually the one route consistently associated with chronic use and thus the one that carries the most risk. In the last several years, several topical NSAIDs including either diclofenac ibuprofen or salicylates for chronic pain have been approved in the United States while similar drugs have been available in Europe for years. One study of a diclofenac topical liquid included an oral diclofenac comparator, and demonstrated no difference in efficacy between the two therapies in treatment for the pain of osteoarthritis in the knee.