Musculoskeletal

Musculoskeletal indications include:

• Osteoarthritis
• Rheumatoid arthritis
• Ankylosing spondylitis

NSAIDs and COX-2 inhibitors reduce the pain and inflammation associated with these conditions but do not affect the progression of the disease.

For this reason, they are now not as commonly used in rheumatoid arthritis. Other groups of drugs, known as disease-modifying anti-rheumatic drugs (DMARDs), prevent or slow down disease progression, and these tend to be used in preference. However, the NSAIDs and COX-2 inhibitors are still useful for reducing pain, particularly during flare-ups.

In osteoarthritis, paracetamol and topical NSAIDs are preferred where possible, because of the side-effects associated with NSAIDs and COX-2 inhibitors. Topical NSAIDs probably have some additional action as a result of massaging in the preparation.

Dysmenorrhoea

Dysmenorrhoea occurs at the beginning of menstruation when the uterus starts to contract frequently, resulting in pain and cramps.

Primary dysmenorrhoea is associated with high levels of prostaglandins, which are responsible for the uterine contractions [13]. This prostaglandin release is blocked by NSAIDs resulting in a reduction in pain and cramping.

Dental

NSAIDs not only have an analgesic effect, but also reduce the inflammation associated with dental procedures such as tooth extraction.

Gout

NSAIDs and COX-2 inhibitors effectively treat flare-ups of acute gout, reducing both the pain and the inflammation. They are also useful when treatment to reduce uric acid levels is initiated, as this can cause an acute gout attack.

Postoperative

By using a combination of analgesic agents, including NSAIDs and COX-2 inhibitors, a patient can receive good levels of postoperative pain relief without needing large quantities of opioids, such as morphine [14]. Consequently the risks of opioid side-effects, such as respiratory depression, are reduced.