Conflict of interest
My child is an employee of Nippon Zoki Pharmaceutical Co., Ltd..
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KEYWORDS
non-steroidal anti-inflammatory drugs, acetaminophen, reverse placebo
effects, analgesic effects, adverse effects
Abstract
There are two simple concrete methods to reduce the dosage of NSAIDs
dramatically. An attending physician is suspected of being a fake doctor
if the blood test is never performed after administration of the
antihyperlipidemic drug. However, the analgesic effects are often not
examined after the administration of analgesics. As with
antihyperlipidemic drugs, efficacy should be examined after
administration of analgesics. Analgesics should not be administered
continuously without examining the analgesic effects. One study shows no
difference in the analgesic effects between NSAIDs and acetaminophen at
the latest 2 weeks after injury or surgery. If NSAIDs are administered
for more than 2 weeks, it is necessary to confirm that NSAIDs are more
analgesic than acetaminophen. If NSAIDs are more analgesic than
acetaminophen, prolonged administration of NSAIDs is acceptable, knowing
that they have more adverse effects than acetaminophen. If the analgesic
effects of both medicines are comparable, acetaminophen should be
administered. These are a matter of course. The two methods reduce the
administration of NSAIDs dramatically, reducing the aforementioned
adverse effects due to NSAIDs dramatically.
1 Introduction
Non-steroidal anti-inflammatory drugs (NSAIDs) are risk factors for
stroke, myocardial infarction, kidney injury, and gastrointestinal
complications, etc. Although concomitant medications can reduce
gastrointestinal complications to some extent, we have no such
medications for stroke, myocardial infarction, and kidney injury. The
administration of NSAIDs should be reduced to reduce those adverse
effects. Because of the high
dosage of NSAIDs worldwide, reduction of them is of great clinical
significance.
There are two simple concrete
methods to reduce the dosage of NSAIDs
dramatically.
2 As with antihyperlipidemic
drugs, efficacy should be examined after administration of analgesics.
An attending physician is
suspected of being a fake doctor if the blood test is never performed
after administration of the antihyperlipidemic drug. If a physician does
never check the efficacy of analgesics after administration, it is a
similar situation. However, the
analgesic effects are often not examined after the administration of
analgesics. I have confirmed this with interviewing patients who had
consulted me and with the medical records of patients who had consulted
me at the medical institutions where I previously worked. I often did
not confirm it, before I specialized in the pharmacological treatment of
pain. Does the previous physician (who may be a physician at the same
medical institution as the readers) of patients who consulted the
readers (physicians) always examine the analgesic effects of analgesics?
Please check the medical records or interview patients. Analgesics
should not be administered continuously without examining the analgesic
effects. Analgesics are classified into analgesics for nociceptive pain
and analgesics for neuropathic pain. Narcotics are effective for both
nociceptive and neuropathic pain. It is necessary to examine the
efficacy in all analgesics. Because placebo cannot be administered in
clinical practice, the analgesic effects may be completely or partially
due to the placebo effects. Traumatic pain usually decreases over time.
Taking this into account, if pain is relieved after administration, we
have to decide that the analgesics are effective. If one analgesic is
determined to be ineffective, we have to choose to discontinue, increase
the dose, or switch to another analgesic.
The efficacy of antihyperlipidemic drugs is easily determined with the
blood test. However, the efficacy of analgesics is determined by a
patient’s statements alone. If the patient’s statements are ambiguous,
the analgesic effects cannot be determined. In that case, the medication
should be discontinued to determine whether the pain changes or not.
Pain sometimes deteriorates after discontinuation of ineffective
analgesics. There is no clear term for this phenomenon, however, I call
it reverse placebo effects. If pain deteriorates after discontinuation
of analgesics, the pain exacerbation may be due to completely or
partially reverse placebo effects. Taking this into account, if pain
deteriorates after discontinuation of analgesics, we have to decide that
the analgesics are effective.
Changing NSAIDs to acetaminophen
can reduce the possibility of reverse placebo effects. Acetaminophen is
analgesic for nociceptive pain as with NSAIDs. They are presumed to be
ineffective for neuropathic pain. In general, acetaminophen is less
analgesic than NSAIDs. However, acetaminophen has far fewer adverse
effects than NSAIDs. Therefore, if the analgesic effects of NSAIDs and
acetaminophen are comparable, acetaminophen should be administered. In
this case, both medicines may be equally effective or equally
ineffective. In both cases, high-risk NSAIDs should not be administered
if their analgesic effects are comparable.
3 When NSAIDs are administered for more than 2 weeks, it is necessary to
confirm that NSAIDs are more analgesic than acetaminophen.
One
study shows no difference in the analgesic effects between NSAIDs and
acetaminophen at the latest 2 weeks after injury or
surgery.1 High-risk NSAIDs should not be administered
if the analgesic effects of both medicines are comparable. Taken
together, if NSAIDs are
administered for more than 2 weeks, it is necessary to confirm that
NSAIDs are more analgesic than acetaminophen.
If NSAIDs are more analgesic than
acetaminophen, prolonged administration of NSAIDs is acceptable, knowing
that they have more adverse effects than acetaminophen. If the analgesic
effects of both medicines are comparable, acetaminophen should be
administered. If acetaminophen is more analgesic than NSAIDs, naturally,
acetaminophen should be administered.
4 Conclusion
When analgesics are administered, the analgesic effects should be
examined. When NSAIDs are administered for more than 2 weeks, it is
necessary to confirm that NSAIDs are more analgesic than acetaminophen.
These are a matter of course.
It is true that this article does
not have novelty and scientific rigor. However, my two recommendations
are often not performed in clinical practice.
The two recommendations reduce
the administration of NSAIDs dramatically, reducing the aforementioned
adverse effects due to NSAIDs dramatically. It is of sufficient
international importance to point out that what should be performed is
often not performed.