Impact of potential inappropriate NSAIDs use in chronic pain

S Ussai, L Miceli, F E Pisa, R Bednarova, A Giordano, G Della Rocca, R Petelin, S Ussai, L Miceli, F E Pisa, R Bednarova, A Giordano, G Della Rocca, R Petelin

Abstract

Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1) the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2) potential inappropriate use. A retrospective 18-months systematic analysis on patients' pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD) or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical code A02B). The yearly cost foran individual who uses NSAIDs for >21 consecutive days as well as concomitant GORD medications is 61.23 euros. In total, 238 subjects (8%) using NSAIDs for >21 days also received one antiplatelet agent. About 11% of subjects received opioids at least once and only 2% of them carried on the therapy for more than 90 consecutive days. In evaluating the escalation in dosage as a proxy of dependence risk, this study shows no dosage escalation in our cohort of chronic pain population - that is to say we show no risk of dependence.

Keywords: dependence; economic impact; pain therapy.

Figures

Figure 1
Figure 1
Prevalence. Abbreviation: NSAIDs, nonsteroidal anti-inflammatory drugs.

References

    1. Rasu RS, Vouthy K, Crow AN, et al. Cost of pain medication to treat adult patients with nonmalignant chronic pain in the United States. J Manag Care Pharm. 2014;20(9):921–928.
    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.
    1. Balding L. The World Health Organisation analgesic ladder: its place in modern Irish medical practice. Ir Med J. 2013;106(4):122–124.
    1. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–517. e202–e205. English, French.
    1. Bjordal JM, Ljunggren AE, Klovning A, Slørdal L. Non-steroidal anti-inflammatory drugs, including cyclo-oxygenase-2 inhibitors, in osteoarthritic knee pain: meta-analysis of randomised placebo controlled trials. BMJ. 2004;329(7478):1317.
    1. Steinman MA, Komaiko KD, Fung KZ, Ritchie CS. Use of opioids and other analgesics by older adults in the United States, 1999–2010. Pain Med. 2015;16(2):319–327.
    1. Sanya EO, Kolo PM, Makusidi MA. A survey on doctors’ knowledge and attitude of treating chronic pain in three tertiary hospitals in Nigeria. Niger Med J. 2014;55(2):106–110.
    1. Fowler TO, Durham CO, Planton J, Edlund BJ. Use of nonsteroidal anti-inflammatory drugs in the older adult. J Am Assoc Nurse Pract. 2014;26(8):414–423.
    1. Graham DY, Opekun AR, Willingham FF, Qureshi WA. Visible small-intestinal mucosal injury in chronic NSAID users. Clin Gastroenterol Hepatol. 2005;3(1):55–59.
    1. Castellsague J, Pisa F, Rosolen V, et al. Risk of upper gastrointestinal complications in a cohort of users of nimesulide and other nonsteroidal anti-inflammatory drugs in Friuli Venezia Giulia, Italy. Pharmacoepidemiol Drug Saf. 2013;22(4):365–375.
    1. Pellicano R. Gastrointestinal damage by non-steroidal anti-inflammatory drugs: updated clinical considerations. Minerva Gastroenterol Dietol. 2014;60(4):255–261.
    1. Liu G, Yan YP, Zheng XX, et al. Meta-Analysis of nonsteroidal anti-inflammatory drug use and risk of atrial fibrillation. Am J Cardiol. 2014;114(10):1523–1529.
    1. Flipo RM. Are the NSAIDs able to compromising the cardio-preventive efficacy of aspirin? Presse Med. 2006;35(Suppl 1):53–60. French.
    1. Serveaux M, Burnier M, Pruijm M. Drugs: an underestimated cause of arterial hypertension. Rev Med Suisse. 2014;10(441):1661–1662. French.
    1. McDowell K, Clements JN. How can NSAIDs harm cardiovascular and renal function? JAAPA. 2014;27(4):12–15.
    1. Ye X, Casaclang N, Mahmud SM. Use of non-steroidal anti-inflammatory drugs and risk of non-Hodgkin lymphoma: a systematic review and meta-analysis. Hematol Oncol. 2014 Oct 23; Epub.
    1. Drug Allergy: Diagnosis and Management of Drug Allergy in Adults, Children and Young People. National Clinical Guideline Centre (UK) 2014 Sep
    1. Messika J, Sztrymf B, Bertrand F, et al. Risks of nonsteroidal antiinflammatory drugs in undiagnosed intensive care unit pneumococcal pneumonia: younger and more severely affected patients. J Crit Care. 2014;29(5):733–738.
    1. Mangoni AA, Knights KM. Non-steroidal anti-inflammatory drugs and risk of stroke in older patients: current controversies and research directions. G Ital Cardiol (Rome) 2011;12(5):341–349.
    1. Mammucari M, Muscas F, Arpino G, Aronica A, Russo P, Visconti M. Role of intensive medical training on Law 38 to improve pain management in primary care. Recenti Prog Med. 2014;105(4):159–165. Italian.
    1. [homepage on the Internet] Florence: Impact Proactive; [Accessed 19 March 2015]. Available from: .
    1. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2008;118(18):1894–1909.
    1. Giummarra MJ, Gibson SJ, Allen AR, Pichler AS, Arnold CA. Polypharmacy and Chronic Pain: Harm Exposure Is Not All about the Opioids. Pain Med. 2014 Oct 3; Epub.

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