NSAID is an abbreviation for nonsteroidal anti-inflammatory drug. Typically thought of as painkillers, NSAIDs can be used to reduce swelling and fever as well as pain. Many common over-the-counter pain medications, including acetaminophen and aspirin, are NSAID drugs, but there are also prescription NSAIDs that were designed to reduce undesirable side effects, such as Celebrex and Vioxx. Many of these specialty NSAIDs have been taken off the market because of concerns that they exacerbate cardiovascular problems, but NSAIDs remain a commonly used class of pharmaceuticals.
Analgesia
NSAIDs share the common purpose of reducing the sensation of pain. By inhibiting the production of a class of chemicals called prostaglandins, which are irritant molecules responsible for pain and inflammation as well as fever, NSAIDs not only increase patient comfort but can also help prevent side effects of fever symptoms, including seizure and brain damage. In fact, the earliest-discovered NSAID, salicin, was consumed as a component of willow bark tea in ancient times. During the 1800's, salicin was chemically manipulated into the drug aspirin, which is now the world's best-selling pharmaceutical.
COX-1 Inhibition
Traditional NSAIDs work by blocking the action two enzymes called the cyclooxygenase enzymes, or COX. These enzymes typically function in tandem in the body, and while they can be turned on or off by various body chemicals, they're generally either both on or both off. Early NSAIDs like aspirin and acetaminophen inhibited both COX enzymes, producing the desired effect of analgesia through turning off COX-2 but also producing undesirable side effects including stomach upset and ulcers. The American Academy of Orthopaedic Surgeons notes that the side effects of traditional NSAIDs are due to their indiscriminate shutting off of both COX enzymes. COX-1 enzymes aren't involved in producing prostaglandins but are involved in maintaining the integrity of the stomach lining, so turning them off is not essential to analgesia and leads to undesirable effects.
COX-2 Inhibition
Newer-generation NSAIDs attempted to produce analgesia through specifically turning off COX-2 enzymes without affecting COX-1, according to Arthritis Today. This had unanticipated consequences, however. For reasons not completely understood, the COX-2 NSAIDs appeared to be detrimental to cardiovascular health and were withdrawn from the market, according to the FDA. In particular, Vioxx, a COX-2 selective inhibitor, was associated with significantly greater risk of heart attack, according to a 2000 study in The New England Journal of Medicine. The British Journal of Anaesthesia says that most physicians choose caution when it comes to prescribing COX-2 selective NSAID drugs. But their ability to reduce the sensation of pain without affecting the integrity of the stomach lining--a factor that limits many patients' ability to take traditional NSAID drugs for long periods of time--make them a valuable tool in appropriate, low-cardiovascular risk cases.
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