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NSAIDs and opioids
BENJAMIN A. WHITE AND STEPHEN H. THOMAS
n Topics covered
n NSAIDs
n Opioids
n Introduction
The NSAIDs and opioids figure prominently in the daily practice of EM. Along
with acetaminophen (paracetamol), these drugs constitute the primary
methods of providing nonspecific pain relief in the acute care setting. The
information in this chapter is intended to provide general reference for
clinicians needing information about the two most commonly used analgesic
classes.
n NSAIDs
Information relevant to the NSAIDs is provided in the table on p. 399. Given
varying drug availabilities in different countries, not every NSAID is covered.
In examining the evidence in this book on acute care use of NSAIDs, some
common themes about this class emerge. First, for many disease processes, a
NSAID is all the analgesic that is needed. Particularly when pain is mild or
moderate, and related to acute injury or inflammation, an agent such as
ibuprofen compares favorably with either acetaminophen or a weak opioid.
In children with musculoskeletal injuries, for instance, well-executed trial
data demonstrate that patients receiving ibuprofen do significantly better
than those given either acetaminophen or codeine. 1 Although the ED physician
should not reflexively prescribe NSAIDs, this class is not a bad place to
start for many patients and acute care conditions.
Once a decision is made to use a NSAID, there is scarce efficacy evidence to
support selecting one agent over another. When nonselective NSAIDs (i.e. not
COX-2 selective NSAIDs) are similarly dosed, there are few (if any) broadly
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