Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration [Should athletic injuries be treated with non-steroidal anti-rheumatic agents (NSAID)? Tenoxicam, piroxicam and placebo in the treatment of acute stress-induced injuries]. Non-steroidal Anti-inflammatory Drugs may Worsen the Course of Community-Acquired Pneumonia: A Cohort Study Perioperative Nonselective Non-steroidal Anti-inflammatory Drugs Are Not Associated with Anastomotic Leakage After Colorectal Surgery The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13-22 weeks gestation. A group-randomized trial of shared decision making for non-steroidal anti-inflammatory drug risk awareness: primary results and lessons learned. Shoulder disorders: a state-of-the-art review Characteristics of subjects experiencing hypersensitivity to non‐steroidal anti‐inflammatory drugs: patterns of response Non-steroidal anti-inflammatory drug use is associated with reduction in recurrence of advanced and non-advanced colorectal adenomas (United States) Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort Association of chronic non-steroidal anti-inflammatory drugs use and cognitive decline in non-demented elderly patients admitted to a geriatric evaluation and rehabilitation unit. Non-steroidal anti-inflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy. Do non-steroidal anti-inflammatory drugs have a significant effect on detection and grading of ultrasound-detected synovitis in patients with rheumatoid arthritis? Results from a randomised study The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Association between non-steroidal anti-inflammatory drugs and keratinocyte carcinomas of the skin among participants in the Veterans Affairs Topical Tretinoin Chemoprevention Trial. A comparison of ketoprofen SR and sulindac in the elderly with rheumatoid arthritis. Acupuncture with non-steroidal anti-inflammatory drugs (NSAIDs) versus acupuncture or NSAIDs alone for the treatment of chronic neck pain: an assessor-blinded randomised controlled pilot study Dabigatran etexilate and concomitant use of non-steroidal anti-inflammatory drugs or acetylsalicylic acid in patients undergoing total hip and total knee arthroplasty: no increased risk of bleeding. Effectiveness of topical non-steroidal anti-inflammatory drugs in the management of breast pain. The comparative analgesic efficacy of transcutaneous electrical nerve stimulation and a non-steroidal anti-inflammatory drug for painful osteoarthritis. Cost effectiveness of COX 2 selective inhibitors and traditional NSAIDs alone or in combination with a proton pump inhibitor for people with osteoarthritis Evidence based educational outreach visits: effects on prescriptions of non-steroidal anti-inflammatory drugs
Superstitions and rituals are commonplace in sports and range from simple activities such as each player touching a special inanimate object before entering the field of play to more extreme behaviours such as not washing a uniform or wearing the same underwear during a winning streak . These practice s are relatively harmless and may reduce precompetition anxiety , but a concerning ritual that has recently developed in sports is the prophylactic use of non-steroidal anti-inflammatory drugs ( NSAIDs ) . Athletes have relatively unrestricted access to NSAIDs , as they are readily available over-the-counter preparations and not considered as performance-enhancing drugs by the World Anti-Doping Agency.1 It has been known for some years that athletes are frequent users of NSAIDS,2 with approximately a quarter of athletes competing at the Sydney 2000 Olympic Games reporting NSAID use in the 3 days before r and om drug testing.3 Such prevalent NSAID use may reflect the physical rigors of elite athletic endeavours , but more recent data suggest athletes misuse their open access to NSAIDs . Tscholl and colleagues4 recently reported in this journal that 23 % of top-level male football players  used NSAIDs  in two out of three matches during the 2002 and 2006 Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP A total of 212 patients with acute sports injuries were allotted at r and om to treatment with 20 mg tenoxicam daily , 20 piroxicam daily or a placebo for ten days . The injuries could be subdivided into six groups : Tendinitis , periostitis , sprains , tendovaginitis , epicondylitis and muscular ruptures . Treatment was well tolerated and analysis of the total material showed a slight but significantly better effect in the group treated with the active drugs . More detailed analysis revealed that this increased effect was produced by a definitely better therapeutic result in the group of patients with tendinitis treated with non-steroid anti-inflammatory drugs ( NSAID ) while , in the other types of injury , no definite effect could be observed . On the basis of these observations , the authors conclude that acute tendinitis may be treated with NSAID ( tenoxicam ) while the question is not yet solved where other acute stress-induced injuries are concerned Purpose Non-steroidal anti-inflammatory drugs ( NSAIDs ) are frequently prescribed or used as self-medication in cases of community-acquired pneumonia ( CAP ) . Nevertheless , the consequences of such medication on the risk of pleuroparenchymal complications are not well known . The aim was to investigate whether exposure to NSAIDs prior to hospital admission among patients suffering from CAP is associated with the development of pleural complications or a lung abscess . Methods All consecutive non-immunocompromised patients with CAP and admitted to a university hospital were prospect ively included ( 2-year period ) . The risk of pleuropulmonary complications was analyzed according to previous exposure to NSAIDs . Results Of the 221 included patients , 40 ( 18.1 % ) had developed a pleuropulmonary complication . NSAIDs intake prior to admission was reported for 24 patients ( 10.9 % ) who were younger ( 50.6 ± 18.5 vs. 66.5 ± 16.4 years ; p = 0.001 ) , had less comorbidities ( 60 vs. 25.1 % ; p = 0.001 ) , had a longer duration between the first symptoms of CAP and the start of an antibiotic therapy ( 6.1 ± 7.6 vs. 2.8 ± 3.8 days ; p = 0.001 ) , and who had a higher incidence of pleuropulmonary complications ( 33.3 vs. 16.2 % ; p = 0.048 ) . In multivariate analyses , two factors were independently associated with the development of pleuroparenchymal complications :  NSAIDs intake [ Odds Ratio ( OR ) = 2.57 [ 1.02–6.64 ] ; p = 0.049 ] and alcohol abuse ( OR = 2.68 [ 1.27–5.69 ] ; p = 0.01 ) . Conclusions Our findings suggest that NSAIDs , often taken by young and healthy patients , may worsen the course of CAP with delayed therapy and a higher rate of pleuropulmonary complications Introduction Recent evidence raises concern about the use of perioperative non-steroidal anti-inflammatory drug ( NSAID ) use after colorectal resection . The purpose of this retrospective cohort study was to investigate the relationship between perioperative ketorolac use and anastomotic leakage after colorectal surgery . Methods A retrospective review ( 2004–2011 ) was performed on patients who underwent elective colorectal surgery .  Univariate analysis and multivariate logistic regression were used to evaluate the association between patients who did not receive any  NSAIDs and those who received ketorolac within the first 5 days perioperatively and leak rate . Results A total of 731 patients were identified as having resection with primary anastomosis : 376 ( 51.4 % ) received no NSAIDs and 355 ( 48.6 % ) received ketorolac perioperatively within 5 days after their surgery . There were 24 ( 3.3 % ) leaks , with 12 in both the no NSAIDs ( 3.2 % ) and ketorolac ( 3.4 % ) groups , odds ratio ( OR ) 1.06 ( 0.43 , 2.62 ; p = 0.886 ) . Adjusting for smoking , steroid use , and age , there remained no significant difference between  ketorolac use and leakage , OR 1.21 ( 0.52 , 2.84 ; p = 0.660 ) . In our multivariate model , only smoking was a significant predictor of postoperative leak , OR 3.34 ( 1.30 , 8.62 ; p = 0.021 ) . Conclusions There does not appear to be a significant association between perioperative ketorolac use and anastomotic leakage after colorectal surgery . However , further prospect i ve studies are needed to confirm our findings before definitive guidelines on NSAID use perioperatively can be recommended BACKGROUND Non-steroidal anti-inflammatory drugs ( NSAIDs ) inhibit the bio synthesis of prostagl and ins and concerns have been expressed that they might attenuate the effects of exogenous prostagl and ins . This r and omized study was conducted to evaluate whether NSAID given during medical abortion with mifepristone/misoprostol in the second trimester has a negative effect on the efficacy of the abortifacient by prolonging the induction-to-abortion interval . METHODS Seventy-four women were treated with the anti-progesterone mifepristone , followed by repeated doses of misoprostol 36 - 48 h later . They were r and omized to receive a prophylactic pain treatment of either paracetamol and codeine or diclofenac with the first dose of misoprostol . RESULTS Co-treatment of NSAID with misoprostol did not attenuate the efficacy of mifepristone and misoprostol . There was no significant difference between the NSAID and the non-NSAID group in the induction-to-abortion interval ( 5.4 versus 6.5 h ) or the total doses of misoprostol needed ( 2 versus 3 ) . The frequency of surgical intervention was similar ( 55.6 versus 52.6 % ) . Women in the group treated with NSAID required significantly less opiates ( P = 0.042 ) . CONCLUSION Co-treatment with NSAID and misoprostol does not interfere with the action of mifepristone and /or misoprostol to induce uterine contractions and pregnancy expulsion in medical abortion . Prophylactic NSAID administration reduces the need for opiate injections RATIONALE , AIMS AND OBJECTIVES Frequent use and serious adverse effects related to non-steroidal anti-inflammatory drugs ( NSAIDs ) underscore the need to raise patient awareness about potential risks . Partial success of patient- or provider-based interventions has recently led to interest in combined approaches focusing on both patient and physician . This research tested a shared decision-making intervention for increasing patient-reported awareness of NSAID risk . METHODS A group r and omized trial was performed in Alabama from 2005 to 2007 . Intervention group doctor practice s received continuing medical education ( CME ) about NSAIDs and patient activation tools promoting risk assessment and communication during visits . Comparison group doctor practice s received only CME . Cross-sectional data were collected before and after the intervention . Generalized linear latent and mixed models with logistic link tested relationships among the intervention , study phase , intervention by study phase interaction and patient-reported awareness of risks with either prescription or over-the-counter ( OTC ) NSAIDs . RESULTS Three hundred and forty-seven patients at baseline and 355 patients at follow-up participated in this study . The intervention [ adjusted odds ratio (AOR)=0.74 , P=0.248 ] , follow-up study phase ( AOR=1.31 , P=0.300 ) and intervention by study phase interaction ( AOR=0.98 , P=0.942 ) were not significantly associated with patient-reported awareness of any prescription NSAID risk . Follow-up study phase was associated with increased odds of reporting any OTC NSAID risk awareness ( AOR=2.99 , P<0.001 ) , but the patient activation intervention and intervention by study phase interaction were not significantly associated with patient-reported awareness of any OTC NSAID risk ( AOR=0.98 , P=0.929 ; AOR=0.87 , P=0.693 , respectively ) . CONCLUSIONS Our point-of-care intervention encouraging shared decision making did not increase NSAID risk awareness This paper provides an up-to- date overview of the occurrence , diagnosis , risk factors , prognostic indicators and outcome of shoulder disorder ( SD ) , and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD . Furthermore , the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) , corticosteroid injections and physiotherapy for SD is summarized on the basis of r and omized controlled trials with an acceptable quality of their methods . The annual incidence of SD is estimated at about 7 % , its 1-year period prevalence at about 51 % and its lifetime prevalence at about 10 % . While approximately 50 % of all patients with SD seek medical care , about 95 % are treated in primary health care . Of all new episodes of SD presenting to primary care , approximately 50 % seem to resolve within 6 months , while about 40 % seem to persist for up to 12 months . Several prognostic indicators for a favourable or a poor outcome of SD have been identified , but a comprehensive prognostic model is not available . While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking , their reproducibility has been shown to be poor . The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care , while their clinical usefulness in primary care and prognostic validity are not . NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks , but their effect on long-term outcome remains unclear . There is very limited evidence for the effectiveness in SD of physiotherapy , including exercise therapy , ultrasound , electrotherapy , laser , mobilization and manipulation Background Non‐steroidal anti‐inflammatory drugs ( NSAIDs ) are one of the most frequently involved groups of medicines in hypersensitivity drug reactions . Two mechanisms can induce the reaction : immunological ( sensitization ) due to a specific IgE or T cell response and pharmacological ( cyclooxygenase inhibition ) . The contribution of each of these mechanisms to the reactions is not well known Objective : To prospect ively examine the association between non-steroidal anti-inflammatory drugs ( NSAIDs ) use ( including dose and dosage schedule ) and the recurrence of colorectal adenomas  among individuals who were diagnosed with an adenoma at entry into a clinical trial . Methods : For this analysis , participants who completed the full follow-up ( n = 1905 ) for the Polyp Prevention Trial ( PPT ) were evaluated . Information on current use and dose of NSAIDs and other drugs was obtained at baseline and at each subsequent study visit over the duration of the trial . The study endpoint was the recurrence of colorectal adenomas in the 3 years between the 1-year trial colonoscopy ( T1 ) and the end of the trial colonoscopy ( T4 ) . Results : There was a significant reduction in overall adenoma recurrence among NSAIDs users ( odds ratio [ OR ] = 0.77 ; 95 % confidence interval [ CI ] : 0.63–0.95 ) , with the greatest effect seen in advanced polyps ( OR = 0.51 ; CI : 0.33–0.79 ) . Among aspirin users , we observed a significant dose response for overall adenoma recurrence , with a 40 % reduction in the OR association ( OR = 0.56 ; 95 % CI : 0.31–0.99 ) among those taking more than 325 mg per day . Conclusion : This prospect i ve study provides further evidence that NSAIDs may play an important role in the chemoprevention of recurrent colorectal adenomas , even those with advanced features Objective To investigate the influence of non-steroidal anti-inflammatory drugs ( NSAIDs ) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis ( AS ) and non-radiographic axial spondyloarthritis ( SpA ) . Methods 164 patients with axial SpA ( 88 with AS and 76 with non-radiographic axial SpA ) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake . Spinal radiographs  were scored by two trained readers in a concealed r and omly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) system . An index of the NSAID intake counting both dose and duration of drug intake was calculated . Results High NSAIDs intake ( NSAID index≥50 ) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units : OR=0.15 , 95 % CI 0.02 to 0.96 , p=0.045 ( adjusted for baseline structural damage , elevated C reactive protein ( CRP ) and smoking status ) in comparison with patients with low NSAIDs intake ( NSAID index<50 ) . This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP : mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake , p=0.02 . In non-radiographic axial SpA , no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found . Conclusion A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS . In non-radiographic axial SpA this effect is less evident , probably due to a low grade of new bone formation in the spine at this stage In a geriatric evaluation and rehabilitation unit ( GERU ) , 258 elderly patients ( M : 71 , F : 187 ; mean age 77.4 + /- 7.5 ) scoring 22 or more at Mini-Mental State Examination ( MMSE ) consecutively admitted were assessed in order to evaluate the effects of non-steroidal anti-inflammatory drugs ( NSAID ) chronic treatment on cognitive status in non-demented elderly patients . Sixty-six patients ( 25.6 % ) were considered chronic NSAID users . Patients chronically assuming NSAADs showed a significantly higher MMSE score than non-users ( 26.9+/-2.1 vs 25.7+/-2.5 , P<0.0005 ) . After controlling for potential confounders in a multivariate model , chronic NSAID use remained independently associated with MMSE score . The results support a positive association between chronic NSAID use and cognitive function in non-demented elderly patients . R and omized controlled trials will be needed to definitively prove this beneficial effect The effects of two non-steroidal anti-inflammatory drugs ( NSAIDs ) , meclofenamate and diclofenac , in combination with physiotherapy modalities on the rate of healing of acute hamstring muscle tears were studied in a double-blind , placebo-controlled trial . Fourty-four of the 75 patients with this injury recruited were assessed and r and omly allocated to one of three treatment groups : meclofenamate ( 100 mg 3 times a day ) , diclofenac ( 50 mg 3 times a day ) and placebo . All patients received the same intensive physiotherapy treatment over the 7-day treatment period . Patient assessment s were performed on days 1 , 3 and 7 of the 7-day study period and included pain assessment ( visual analogue scale ) , swelling measurement ( thigh circumference measurement at the site of the muscle tear ) and isokinetic muscle performance testing . Treatment produced a significant improvement in all measurements in all groups , but there was no difference in any measurement between groups . However , when only the more severe injuries were analysed , the reported pain score at day 7 was significantly lower in the placebo group than in either the meclofenamate group or the diclofenac group ( P < 0.05 ) . Hence this study did not find any additive effect on the healing of acute muscle injuries when meclofenamate or diclofenac was added to st and ard physiotherapeutic modalities . The study therefore does not support the use of NSAIDs in the treatment of acute hamstring muscle injuries Objectives To determine whether non-steroidal anti-inflammatory drugs ( NSAIDs ) have a significant effect on ultrasonographic ( US ) grey scale ( GS ) and power Doppler ( PD ) assessment of synovitis in rheumatoid arthritis ( RA ) . Methods Patients with RA taking NSAIDs were r and omised to either stopping ( for a minimum of 5 drug half-lives ) or continuing the drug . All patients had a clinical assessment and US examination of both h and s and wrists before and after stopping/continuing the NSAID . Changes at follow-up were compared between groups using Mann – Whitney U tests . Results A total of 58 patients with RA were recruited . All the clinical assessment parameters ( including disease activity , pain , general state of health and physician global visual analogue score and tender and swollen joints count ) showed an increase in the group who stopped their NSAID treatment . The total GS and PD score showed median ( first to third quartiles ) increase of 9.5 ( 5.75 to 19.0 ) and 4.0 ( 2.0 to 6.0 ) per patient , respectively , in the patients who stopped their NSAID in comparison with 1.0 ( –1.0 to 2.25 ) and 0.0 ( –2.0 to 3.0 ) , respectively , in the patients who continued their NSAID ( p<0.001 ) . There was an increase in the number of joints scoring > 0 for GS and PD in the patients who stopped the NSAID . The inter- and intrareader agreement was good to excellent for the US examination . Conclusion NSAID usage may mask the GS and PD signal and result in lower scoring despite continuing disease activity . Consideration should be given to the NSAID effect in design ing clinical studies which use US to assess response to therapeutic To determine the safety and efficacy of viscosupplementation with hylan G-F 20 , a cross-linked hyaluronan preparation , used either alone or in combination with continuous non-steroidal anti-inflammatory drug ( NSAID ) therapy , a r and omized , controlled , multicenter clinical trial , assessed by a blinded assessor , was conducted in 102 patients with osteoarthritis ( OA ) of the knee . All patients were on continuous NSAID therapy for at least 30 days prior to entering the study . Patients were r and omized into three parallel groups : ( 1 ) NSAID continuation plus three control arthrocenteses at weekly intervals ; ( 2 ) NSAID discontinuation but with three weekly intra-articular injections of hylan G-F 20 ; and ( 3 ) NSAID continuation plus three injections , one every week , intra-articular injections of hylan G-F 20 . Outcome measures of pain and joint function were evaluated by both the patients and an evaluator at baseline and weeks 1 , 2 , 3 , 7 and 12 , with a follow-up telephone evaluation at 26 weeks . At 12 weeks all groups showed statistically significant improvements from baseline , but did not differ from each other . A statistical test for the equivalence , the q-statistic , demonstrated that viscosupplementation with hylan G-F 20 was at least as good or better than continuous NSAID therapy for all outcome measurements except activity restriction . At 26 weeks both groups receiving hylan G-F 20 were significantly better than the group receiving NSAIDs alone . A transient local reaction was observed in three patients after hylan G-F 20 injection ; only one patient withdrew from the study as a result and all recovered without any sequela . Hylan G-F 20 is a safe and effective treatment for OA of the knee and can be used either as a replacement for or an adjunct to NSAID therapy PURPOSE Observational studies have reported significant negative associations between sporadic non-steroidal anti-inflammatory drug ( NSAID ) use and keratinocyte carcinoma ( KC ) while reporting null results for regular use . This pattern may be partially explained by the operational expression of NSAID exposure and analytic model assumptions . Our goals were to quantify the association between NSAIDs and KC and to explore the impact of exposure metrics and modeling assumptions on observed associations . METHODS We conducted a prospect i ve cohort study by linking data from the Veterans Affairs Topical Tretinoin Chemoprevention Trial and the VA Pharmacy Benefits Management data base .  NSAID use was categorized according to cyclooxygenase selectivity , timing of initiation , and frequency of use . Data were analyzed using time-varying and time-fixed multivariable-adjusted Cox proportional hazard models [ Correction made here after initial online publication ] . Simulated null data were generated and analyzed to explore potential biases introduced by the models and the exposure metrics . RESULTS During a median follow-up time of 2 years for basal cell carcinoma and 2.5 years for squamous cell carcinoma , 472 occurrences of BCC and 309 occurrences of SCC were observed . Time-fixed analyses of NSAID exposure metrics produced significant negative associations , whereas time-varying analyses produced null results . Analysis of simulated null data revealed the potential for strong bias in the time-fixed analyses . CONCLUSIONS This study did not identify a negative association between NSAIDs and KC . The disparity between the time-fixed and the time-varying analyses highlights the extent to which operational definitions of drug exposures and reliance on time-fixed methods may introduce bias The elderly ( age > 65 years ) are more vulnerable to side-effects induced by non-steroidal anti-inflammatory drugs ( NSAIDs ) . We therefore performed a double-blind comparative study of ketoprofen SR and sulindac in patients with active rheumatoid arthritis , 65 years of age or older .  Sulindac was chosen because of its possible renal sparing effects , and ketoprofen SR because of its short half life and sustained release delivery system . Eighty patients were entered . More patients withdrew from the study due to side-effects in the sulindac group ; both treatment groups had a high incidence of side-effects during this study and during previous exposure to other NSAIDs , demonstrating that the elderly are susceptible to side-effects from NSAIDs Objective To investigate the feasibility and sample size required for a full-scale r and omised controlled trial of the effectiveness of acupuncture with non-steroidal anti-inflammatory drugs ( NSAIDs ) for chronic neck pain compared with acupuncture or NSAID treatment alone . Methods A total of 45 patients with chronic neck pain participated in the study . For 3 weeks the acupuncture with NSAIDs treatment group took NSAIDs ( zaltoprofen , 80 mg ) daily while receiving acupuncture treatment three times a week . The acupuncture treatment group received treatment three times a week and the NSAID treatment group took NSAIDs daily . The primary outcomes were to determine the feasibility and to calculate the sample size . As secondary outcomes , pain intensity and pain-related symptoms for chronic neck pain were measured . Results With regard to enrolment and dropout rates , 88.2 % of patients consented to be recruited to the trial and 15.6 % of participants were lost to follow-up . The sample size for a full-scale trial was estimated to be 120 patients . Although preliminary , there was a significant change in the visual analogue scale ( VAS ) for neck pain intensity between the baseline measurement and each point of assessment in all groups . However , there was no difference in VAS scores between the three groups . Conclusions This pilot study has provided the feasibility and sample size for a full-scale trial of acupuncture with NSAIDs for chronic neck pain compared with acupuncture or NSAID treatment alone . Further research is needed to vali date the effects of acupuncture with NSAIDs . Clinical Trial Registration NIH Clinical Trials.gov NCT01205958 Patients undergoing total hip or knee arthroplasty should receive anticoagulant therapy because of the high risk of venous thromboembolism . However , many are already taking non-steroidal anti-inflammatory drugs ( NSAIDs ) or acetylsalicylic acid ( ASA ) that can have antihaemostatic effects . We assessed the bleeding risk in patients treated with thromboprophylactic dabigatran etexilate , with and without concomitant NSAID or ASA .  A post-hoc analysis was undertaken of the pooled data from trials comparing dabigatran etexilate ( 220 mg and 150 mg once daily ) and enoxaparin .  Major bleeding event ( MBE ) rates were determined and odds ratios ( ORs ) generated for patients who received study treatment plus NSAID ( half-life ≤12 hours ) or ASA ( ≤160 mg/day ) versus study treatment alone . Relative risks were calculated for comparisons between treatments . Overall , 4,405/8,135 patients ( 54.1 % ) received concomitant NSAID and 386/8,135 ( 4.7 % ) received ASA.ORs for the comparison with/without concomitant NSAID were 1.05 ( 95 % confidence interval [ CI ] 0.55 - 2.01 ) for 220 mg dabigatran etexilate ; 1.19 ( 0.55 - 2.55 ) for 150 mg ; and 1.32 ( 0.67 - 2.57 ) for enoxaparin . ORs for the comparison with/without ASA were 1.14 ( 0.26 - 5.03 ) ; 1.64 ( 0.36 - 7.49 ) ; and 2.57 ( 0.83 - 7.94 ) , respectively . For both NSAIDs and ASA there was no significant difference in bleeding between patients with and without concomitant therapy in any treatment arm . Patients concomitantly taking NSAIDs or ASA have a similar risk of MBE to those taking dabigatran etexilate alone . No significant differences in MBE were detected between dabigatran etexilate and enoxaparin within co-medication subgroups , suggesting that no increased major bleeding risk exists when dabigatran etexilate is administered with NSAID or ASA A prospect i ve study of the effectiveness of the topical application of non-steroidal anti-inflammatory drugs ( NSAIDs ) as a gel preparation was carried out in 26 women with severe breast pain . The results showed a satisfactory relief of pain in 81 % of the women : 11 of 13 with cyclical pain , eight of 11 with non-cyclical pain , and in two women with severe scar pain after lumpectomy and radiotherapy .  Topical NSAID gel was applied as required ; the relief of severe pain was rapid and no side effects were reported . These factors compare favourably with established recommended treatments which usually involve months of continuous treatment , tailoring of drug dosages and a significant incidence of intolerable side effects . This study has shown that topical NSAID application is an effective , safe , acceptable and easily administered treatment for severe cyclical and non-cyclical breast pain Thirty-six non-hospitalized subjects with chronic pain from OA of the knee participated in an evaluation of transcutaneous electrical nerve stimulation ( TENS ) and naproxen , an NSAID . All pre-experiment treatment was withdrawn . Each subject experienced in some order three 3-week treatment phases : NSAID plus placebo TENS ; TENS plus placebo drug ; and double placebo . A broad range of pain measures was used , including daily diary ratings , and four-times-per-day ratings entered into a small electronic data logger ( the PIPER ) worn by the subject . A substantial placebo response occurred across all conditions , which may have masked treatment differences . Broad comparisons across subjects , combining the four main measures of pain , found no significant differences among the three experimental treatments . Analysis of diary and PIPER data for individuals suggested that , in a small minority of subjects , the NSAID plus placebo TENS combination may be more effective than double placebo . The PIPER ratings seemed to tap aspects of the pain experience different from those captured by conventional measures , suggesting the value of very frequent pain assessment s , such as those entered by a subject into the PIPER , in the study of chronic pain Objectives To investigate the cost effectiveness of cyclo-oxygenase-2 ( COX 2 ) selective inhibitors and traditional non-steroidal anti-inflammatory drugs ( NSAIDs ) , and the addition of proton pump inhibitors to these treatments , for people with osteoarthritis . Design An economic evaluation using a Markov model and data from a systematic review was conducted . Estimates of cardiovascular and gastrointestinal adverse events were based on data from three large r and omised controlled trials , and observational data were used for sensitivity analyses . Efficacy benefits from treatment were estimated from a meta- analysis of trials reporting total Western Ontario and McMaster Universities ( WOMAC ) osteoarthritis index score . Other model inputs were obtained from the relevant literature . The model was run for a hypothetical population of people with osteoarthritis . Subgroup analyses were conducted for people at high risk of gastrointestinal or cardiovascular adverse events . Comparators Licensed COX 2 selective inhibitors ( celecoxib and etoricoxib ) and traditional NSAIDs ( diclofenac , ibuprofen , and naproxen ) for which suitable data were available were compared . Paracetamol was also included , as was the possibility of adding a proton pump inhibitor ( omeprazole ) to each treatment . Main outcome measures The main outcome measure was cost effectiveness , which was based on quality adjusted life years gained . Quality adjusted life year scores were calculated from pooled estimates of efficacy and major adverse events ( that is , dyspepsia ; symptomatic ulcer ; complicated gastrointestinal perforation , ulcer , or bleed ; myocardial infa rct ion ; stroke ; and heart failure ) . Results Addition of a proton pump inhibitor to both COX 2 selective inhibitors and traditional NSAIDs was highly cost effective for all patient groups considered ( incremental cost effectiveness ratio less than £ 1000 ( € 1175 , $ 1650 ) ) . This finding was robust across a wide range of effectiveness estimates if the cheapest proton pump inhibitor was used . In our base case analysis , adding a proton pump inhibitor to a COX 2 selective inhibitor ( used at the lowest licensed dose ) was a cost effective option , even for patients at low risk of gastrointestinal adverse events ( incremental cost effectiveness ratio approximately £ 10 000 ) . Uncertainties around relative adverse event rates meant relative cost effectiveness for individual COX 2 selective inhibitors and traditional NSAIDs was difficult to determine . Conclusions Prescribing a proton pump inhibitor for people with osteoarthritis who are taking a traditional NSAID or COX 2 selective inhibitor is cost effective . The cost effectiveness analysis was sensitive to adverse event data and the specific choice of COX 2 selective inhibitor or NSAID agent should , therefore , take into account individual cardiovascular and gastrointestinal risks Aims : To evaluate the effectiveness of an evidence based group educational outreach visit on prescription patterns of  non-steroidal anti-inflammatory drugs ( NSAIDs ) in primary care . Design : R and omised controlled simple blind trial , with r and omisation into three groups : experimental ( evidence based educational outreach visit ) , placebo ( conventional education session ) , and control ( without intervention ) . Setting : The 24 primary care centres of the National Institute of Healthcare Network in a rural province of Aragon , Spain . Participants : The 24 primary health care teams of the network , with 158 general practitioners ( GPs ) . The teams were r and omised into the groups , experimental ( 8 teams , 48 GPs ) , placebo ( 8 teams , 54 GPs ) , and control ( 8 teams , 56 GPs ) . Intervention : Experimental group : one group educational outreach visit , conveying data based on a systematic review of the literature that was reinforced with printed material ; placebo group : one non-structured educational session ; control group : no intervention . Both educational sessions emphasised that there are no differences in the effectiveness of the NSAIDs review ed ( diclofenac , piroxicam , and tenoxicam ) ; a recommendation was made to prescribe diclofenac over tenoxicam because of price differences . Main outcome measures : Changes in the number of packages prescribed for each of the drugs and changes in the cost per package of NSAIDs prescribed during the six months before , and after the intervention . Results : There were no differences in the basal characteristics of the three groups , except for the number of prescriptions during the six months before the intervention . Prescriptions for NSAIDs decreased homogeneously in the three groups . For tenoxicam , the experimental group reduced prescriptions by 22.5 % ( 95%CI : 34.42 to −10.76 ) , compared with a reduction of 9.78 % ( 95%CI : −17.70 to −1.86 ) in the placebo group and an increase of 14.44 % ( 95%CI : 5.22 to 23.66 ) in the control group . The average cost per prescription decreased by 1.91 % ( 95%CI : −0.33 % to −3.49 % ) in the experimental group , 0.16 % ( 95%CI : −0.27 % to −2.93 % ) in the placebo group , and rose by 1.76 % ( 95%CI : 0.35 % to 3.17 % ) in the control group . Conclusions : Evidence based educational outreach visits are more effective than no intervention at all . Results suggest that evidence based educational outreach visits are incrementally more effective than conventional educational sessions , which in turn are more effective than no intervention at all
There was neither significant difference in the maximum performance between NSAIDs and control groups nor in the time until exhaustion nor in self-perceived pain .
Non-steroidal anti-inflammatory drugs ( NSAIDs ) are medications that are frequently used by athletes .
There may also be some abuse of these substances , although it is unclear whether NSAIDs in fact enhance performance .
We performed a systematic review and meta- analysis to evaluate the effect of NSAIDs on sport performance indices .