Nonsteroidal Agents

Nonsteroidals function by altering the peripheral and central sensiti-zation of the products of inflammation. When applied to peripheral pain fibers, prostaglandins (PGE2 in particular) amplify the experience of pain. Nonsteroidals block the cyclooxygenase (COX) enzymes that oversee production of PGE2 and, thus decrease the amount of prostaglandin. These pharmaceuticals are commonly used to treat pain syndromes characterized by inflammation or by mild pain. Non-steroidals are also used to decrease the dosage of opioids required to control pain.

Unfortunately, traditional nonselective prostaglandin inhibitors also block the production of the constitutive enzymes required to protect gastrointestinal mucosa and platelet function. For this reason, pharmaceutical companies developed newer classes of nonsteroidals that selectively block the COX-2 enzyme. These agents appear to have a similar efficacy to the traditional nonsteroidals and to offer a marked improvement in the safety profile.

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