Limitations of NSAIDs for pain management: Toxicity or lack of efficacy?

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in the manage ment of arthritis and acute and chronic pain of many etiologies, including cancer-related pain. These drugs are indicated for use as single agents in mild to moderate pain and in combination with opioid analgesics or adjuvant analgesic drugs in severe pain. NSAIDs, which nonselectively inhibit the c yclooxygenase enzymes (isoenzymes 1 and 2), pose a potentially serious risk of gastrointestinal toxicity with acute and chronic use, hematologic toxic ity with acute use, and nephrotoxicity with chronic use. Patients experienc ing acute and chronic pain associated with serious and even life-threatenin g medical illness such as cancer and human immunodeficiency virus/aquired i mmune deficiency syndrome (HIV/AIDS) fall into a high-risk group with respe ct to the use of NSAIDs. This is so because the occurrence of gastrointesti nal bleeding and the masking of opportunistic infections related to the ant ipyretic effects of NSAIDs pose particular risk and might even cause lethal complications in patients who are neutropenic, thrombocytopenic, or otherw ise immunocompromised.