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What is the Role of NSAIDs in Pre-emptive Analgesia?

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Abstract

NSAIDs inhibit the cyclo-oxygenase enzymes, and decrease peripheral and central prostaglandin production. In addition to reducing the inflammation that accompanies tissue injury, decreasing prostaglandin production attenuates the response of the peripheral and central components of the nervous system to noxious stimuli. Such a reduction in the response to pain can reduce the peripheral and central sensitisation induced by noxious stimuli, and reduce the pain experienced in response to subsequent noxious stimuli. These properties would seem to make NSAIDs ideal drugs to use in a pre-emptive fashion, where analgesics are administered prior to a noxious stimulus, such as surgery, with the expectation that reduction in peripheral and central sensitisation will lead to a decrease of pain.

However, the available perioperative trials of pre-emptive NSAID use have yielded modest or equivocal results, and these may be due, in part, to controversy associated with the definition of pre-emptive analgesia and how to conduct the corresponding clinical trials. Although NSAIDs may have a limited ability by themselves to induce a pre-emptive analgesic effect, the available trials suggest how the perioperative use of these drugs may be made more effective. It is expected that NSAIDs will play an increasing role in multimodal analgesia and pain relief in general.

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Acknowledgements

Dr Ochroch is supported by grant K23-HD-040914 from the National Institutes of Health. Dr Mardini is supported by the McCabe Fund. Dr Gottschalk is supported by grant NS41865 from the National Institutes of Health. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

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Authors and Affiliations

  1. Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    E. Andrew Ochroch & Issam A. Mardini

  2. Department of Pharmacology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

    Issam A. Mardini

  3. Department of Anesthesiology and Critical Care Medicine, Meyer 8-134, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, Maryland, 21287, USA

    Allan Gottschalk

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  1. E. Andrew Ochroch
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  2. Issam A. Mardini
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Correspondence to Allan Gottschalk.

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Ochroch, E.A., Mardini, I.A. & Gottschalk, A. What is the Role of NSAIDs in Pre-emptive Analgesia?. Drugs 63, 2709–2723 (2003). https://doi.org/10.2165/00003495-200363240-00002

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