Daniel S Goldberg: ude. This article has been cited by other articles in PMC. Abstract Background Pain is an enormous problem globally. Nevertheless, the problem of pain has primarily been regarded as a medical problem, and has been little addressed by the field of public health.
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Abstract Pain affects the quality of life for millions of individuals and is a major reason for healthcare utilization. As populations age, medical personnel will need to manage more and more patients suffering from pain associated with degenerative and inflammatory musculoskeletal disorders. Nonsteroidal anti-inflammatory drugs NSAIDs are an effective treatment for both acute and chronic musculoskeletal pain; however, their use is associated with potentially significant gastrointestinal GI toxicity.
Older studies suggest that high-dose H2RAs are effective in preventing upper GI ulcers and dyspepsia. Introduction It is estimated that at least 50 million people in the United States suffer from chronic pain conditions while an additional 25 million people suffer from acute pain [ 1 ]. NSAIDs and gastrointestinal toxicity While NSAIDs are effective for the treatment of pain and are overall well tolerated, their use is associated with potentially important adverse effects.
While most patients who develop NSAID-induced ulcers do not develop clinical events, the annual rate of upper GI clinical events is approximately 2. Reports in the literature estimate 3, to 16, deaths each year in the United States from complications of NSAID-associated ulcer perforations and bleeding [ 10 - 13 ].
Additionally, an estimated , hospitalizations occur each year in the United States due to NSAID-associated ulcer perforations and bleeding [ 11 ]. Several well-established factors have been identified that significantly increase this risk. Review of current guidelines Current guidelines for the management of patients who need pharmacotherapy for treatment of pain both acknowledge the risk of GI clinical events associated with NSAIDs as well as address the factors known to increase the risk.
Although subsequent to this report, less expensive generic and over-the-counter PPIs have become available that would reduce the cost of PPI gastroprotection considerably.
There has not been a follow-up cost-effectiveness study incorporating lower priced PPIs nor are there head-to-head comparative studies evaluating efficacy of the competing strategies. Pharmacokinetics H2RAs inhibit acid secretion by competitively blocking histamine type-2 receptors on the parietal cell, thus reducing basal and stimulated gastric acid secretion.
Pepsin secretion is also reduced, which results in decreased peptic activity [ 19 ]. PPIs instead block acid secretion by irreversibly binding to and inhibiting the hydrogen-potassium ATPase pump on the luminal surface of the parietal cell membrane. Absorption of H2RAs is reduced by concurrent antacid administration. Likewise, PPIs which rely on an activated parietal cell work less well in persons also taking other antisecretory agents such as misoprostol or an H2RA.
There does, however, appear to be a dose-response relationship between H2RAs and gastric ulcer prevention and healing. Both a meta-analysis and a Cochrane review found that standard doses of H2RAs were effective at reducing the risk of duodenal but not gastric NSAID-associated ulcers [ 21 , 22 ].
High-dose H2RAs were associated with a statistically significant reduction in the risk of both duodenal and gastric ulcers compared with placebo. Furthermore, high-dose H2RAs significantly reduced symptoms of abdominal pain compared with placebo [ 22 ].
The use of H2 antagonists in treating and preventing NSAID-induced mucosal damage
References 1. Beyond the Tower of Babel: a nomenclature for suicidology. Suicide Life Threat Behav. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.
Pain as a global public health priority
Abstract Pain affects the quality of life for millions of individuals and is a major reason for healthcare utilization. As populations age, medical personnel will need to manage more and more patients suffering from pain associated with degenerative and inflammatory musculoskeletal disorders. Nonsteroidal anti-inflammatory drugs NSAIDs are an effective treatment for both acute and chronic musculoskeletal pain; however, their use is associated with potentially significant gastrointestinal GI toxicity. Older studies suggest that high-dose H2RAs are effective in preventing upper GI ulcers and dyspepsia.
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Gugal People suffering from chronic pain often rely solely on medications for relief and avoid movement or activity for fear of exacerbating their discomfort—referred to as kinesiophobia. Prescription opioid analgesics are used to treat pain from surgery, injury, and health conditions such as cancer. Trend in prescription opioid analgesic use in the past 30 days among adults aged 20 and over: For the other race and Hispanic origin groups, no cnhs differences were observed between men and women. Programs and Collection Procedures Series 2. Data From Special Surveys Series Interview sample weights, accounting for the differential probabilities of selection, nonresponse, and noncoverage, were used for analyses. Data Evaluation and Methods Research Series 3.
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Data on Health Resources Series Women aged 60 and over were more likely to use opioids 8. Non-Hispanic white men were more likely to use opioid analgesics 7. Has the percentage changed since —? Statistical analyses were conducted using the SVY commands in Stata Nine opioid analgesics with the ingredient category code 59 miscellaneous analgesics were also included. How are you marketing to individuals with chronic pain? For the other age groups, no significant differences in the use of opioids were observed between men and women.