NSAIDs relieve osteoarthritis (OA) pain, but cardiovascular safety in question even for diclofenac, ibuprofen, naproxen, and celecoxib: what are the alternatives?

Abstract

Citing the excellent editorial comment by Pekka Mäntyselkä 10 years ago in PAIN on the “Balancing act with geriatric pain treatment”, World Health Organisation predicts that there will be 1.2 billion people above 60 years by 2025, 2 billion by 2050, and in the developed world the very old, aged 80+, is the fastest growing population group. Persistent pain, due to degenerative diseases, osteoarthritis (OA) in particular, becomes more prevalent as a person ages [ 1 ] [1] . Comorbidities and polypharmacies increasingly pose dilemmas with increasing risks of interactions and serious side effects. Pain and dysfunction from OA are poorly relieved [ 2 ] [2] , but NSAIDs (traditional tNSAIDs and COX-2 specific inhibitors – COXIBs) are still recommended as cornerstones in the pharmacological treatment of OA [ 3 ] [3] .