Pain relievers like NSAIDs act on prostaglandin to alleviate pain. Prostaglandin is a chemical produced by an enzyme called Cyclooxygenase (COX). However, in 1992, it was discovered that there are two kinds of prostaglandin present in our bodies. The prostaglandin generated by COX-1 helps maintain the natural protective lining in the stomach, while the prostaglandin produced by COX-2 is the one responsible for body pain and inflammation. Due to the NSAIDs' inhibitory effect on both COX-1 and COX-2 (Cyclooxygenase 1 & 2), NSAIDs may effectively relieve pain but may also inadvertently affect the protective lining of the stomach, thus causing gastro-intestinal problems like - nausea, heartburn, belching, and sometimes even perforations, ulcers and bleeding.
However, with the emergence of a new class of pain relief medication called COXIBs or COX-2 Inhibitors, the stomach is spared from these side effects. Numerous clinical studies worldwide have shown the effectiveness and safety of COXIBs such as rofecoxib. Coxibs demonstrated no effect on COX-1, even when the dosage was largely increased for the treatment of osteoarthritis. This meant sparing patients from stomach discomfort and other gastro-intestinal side effects like nausea, belching, gastric perforations, ulcers and bleeding, which traditional NSAIDs may cause especially when used on a long term basis. To provide adequate pain relief for osteoarthritis patients, the coxib's starting dosage was comparable to that of high doses of other analgesics - proving it to be a very powerful and effective pain reliever. Moreover, coxibs can be taken
anytime of the day, with or without meals. Unlike the more popularly known and used pain pills, which have to be taken during or after a meal, coxibs can be taken before breakfast, before bedtime, or even in the middle of the night, all with an empty stomach. This is because coxibs don't adversely affect the stomach lining. With post-operative dental pain, post-operative orthopedic surgical pain and primary dysmenorrheal pain, coxibs provided relief to pain which rated moderate to severe.
Gentle on the stomach, but tough on pain, coxibs like rofecoxib have been proven effective in relieving not only chronic pain but also acute pain as well. Post-operative pain is known to be intense and oftentimes intolerable, particularly within the 24 hours after the surgery, necessitating the use of very powerful pain medications. Following major surgery, Dr. Adriano Laudico, noted surgeon and PMIA chairman, combines opioid analgesics (morphine) together with rofecoxib on his post-surgical patients to provide optimum pain relief. This, he says, has proven to be very effective. However, Dr. Laudico would advise people with osteoarthritis, rheumatoid arthritis, dysmenorrhea and other types of acute pain, to consult their doctor and find out more about this new breakthrough in pain medication.
For comments and insights, please write to Pain Management Information Agency (PMIA) P.O. Box 3485 Makati, fax 892-3968 or e-mail at paincare@pmia.com.ph. PMIA was established primarily to increase public awareness and understanding of pain and to recommend appropriate medical and practical ways to manage and control pain.