The use of NSAIDs and paracetamol (acetaminophen) in chronic pain

Nonsteroidal anti-inflammatory drugs (NSAID) are widely used by prescription and as over the counter medicines but their side effects may be life-threatening. Theoretically, the newer cyclooxygenase-2 antagonists have potential benefits but should be used with great caution in patients with concurrent cardiac disease. Clinically, NSAIDs with the lowest risk should be tried first, at the lowest recommended dose and only after having first assessed the efficacy of paracetamol. The use of NSAIDs and paracetamol in chronic pain is discussed together because of their common convention of usage. NSAIDs are prescribed for pain associated with the inflammatory arthritides, osteoarthritis, musculoskeletal disorders, dysmenorrhea, and mild to moderate pain. NSAIDs have a good safety record but, due to the enormous quantities prescribed, they account for a large proportion of serious adverse drug events. Gastrointestinal side effects of NSAIDs range from mild dyspepsia to severe and even fatal perforated and bleeding ulcers.