RATIONAL USE OF ANALGESICS' IN THE PATIENT WITH CARDIOVASCULAR DISEASE: WHAT DOES THE EVIDENCE TELL US?

Author(s): 
AL JONES 1
1 University of Newcastle, Australia
Text: 
BACKGROUND: In September 2004, just 5 years after its launch, the prescription pain reliever rofecoxib was withdrawn from the market amidst issues over its cardiovascular safety. Evidence that rofecoxib increases the risk of myocardial infarction led to scrutiny of other non-steroidal anti-inflammatory drugs (NSAIDs ).1 This presentation will review the current literature, giving insight into the latest data on managing pain in patients with cardiovascular risks and providing a series of recommendations for use in general practice. Gastrointestinal (GI) considerations will also be explored, with particular emphasis on the increase in risk of GI adverse events when NSAID or coxibs are co-administered with low-dose aspirin.
The underlying message is clear; it is important to assess a person's individual risk before deciding whether to recommend any NSAID. Paracetamol remains the analgesic of choice for mild-to-moderate persistent pain, it has a more favourable adverse-effect profile, making it a suitable first choice for many.' If treatment with paracetamol alone does not provide sufficient pain relief, then adding a short course of an NSAID to regular paracetamol should be considered. 3
Pain is a common clinical problem. Although some patients will inevitably seek the advice of their GP for pain management, particularly for chronic pain or pain that interferes with their daily activities, a large proportion of people are already self-treating or will have tried to manage their pain themselves before talking to their doctor.4 Practical advice will be provided on the relative roles of paracetamol and NSAIDs and their effects in overdose.