Myths in EM: The Anti-Inflammatory Properties of NSAIDs
A Cochrane database review from 2015 compared NSAIDs to other analgesics for acute soft-tissue injuries. It concluded, “There is generally low- or very low-quality but consistent evidence of no clinically important difference in analgesic efficacy between NSAIDs and other oral analgesics.”3 This review implies that if acute inflammation does exist with such injuries, either NSAIDs do not provide a clinically significant benefit in reducing inflammation or inflammation is not a significant contributor to symptoms of those injured.
Continuing with this theme are two additional Cochrane reviews. The first evaluated NSAIDs for the treatment of acute gout. One would suspect clear benefit from NSAIDs in a condition widely accepted as inflammatory in nature. After reviewing 23 trials, the authors concluded that limited evidence existed to support NSAID use for the treatment of acute gout.4 The second reviewed the same but for spondyloarthritis. NSAIDs were efficacious based on several functional scoring tools, and there was a trend toward reduced radiographic spinal progression.5 Thus, NSAIDs most likely provide benefit in chronic inflammatory conditions.
The concept of the anti-inflammatory effect of NSAIDs is largely a physiologic argument. If we believe NSAIDs reduce inflammation and other mechanisms of bone healing, we are forced to subscribe to the belief of some of our orthopedic colleagues that NSAIDs impede fracture healing. Many articles have been published citing these hypothetical concerns about inhibited fracture healing and studying animal models suggesting the same.
March 19, 2019 - 1 Comment
March 12, 2019 - 0 Comment
January 14, 2019 - 0 Comment
About the Author
Kevin M. Klauer, DO, EJD, FACEP, is Chief Medical Officer–hospital-based services and Chief Risk Officer for TeamHealth as well as the Executive Director of the TeamHealth Patient Safety Organization. He is a clinical assistant professor at the University of Tennessee and Michigan State University College of Osteopathic Medicine. Dr. Klauer served as editor-in-chief for Emergency Physicians Monthly publication for five years and is the co-author of two risk management books: Emergency Medicine Bouncebacks: Medical and Legal and Risk Management and the Emergency Department: Executive Leadership for Protecting Patients and Hospitals. Dr. Klauer also serves on the ACEP Board.
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With regard to state legislative activity regulating the opioid prescribing practices of emergency physicians, which of the following wouId you support? Check all that apply.
- Restrictions on duration (36%, 229 Votes)
- Restrictions of quantity (34%, 219 Votes)
- Mandatory checking of prescription drug monitoring systems for all opioid prescriptions from the ED (30%, 194 Votes)
Total Voters: 367