Impact of potential inappropriate NSAIDs use in chronic pain
Open accessAbstract
Pain remains one of the main reasons for medical consultation worldwide: moderate- to severe-intensity pain occurs in 19% of adult Europeans, seriously affecting the quality of their social and working lives. Nonsteroidal anti-inflammatory drugs (NSAIDs) are not recommended for long-term use and a careful surveillance to monitor for toxicity and efficacy is critical. This study aims to assess: 1) the pattern of use of NSAIDs and opioids in a population covered by a cloud-based pharmacovigilance surveillance system; and 2) potential inappropriate use. A retrospective 18-months systematic analysis on patients' pain treatment was performed. The primary endpoint was evaluating the prevalence of NSAIDs and opioids use and the duration of therapy regimen. The secondary endpoint was to investigate the prevalence of NSAIDs taken for >21 consecutive days concomitant with drugs for peptic ulcer and gastroesophageal reflux disease (GORD) or antiplatelet drugs. The yearly cost for individual users of concomitant NSAIDs for more than 21 consecutive days and of GORD medications has been estimated. A total of 3,050 subjects with chronic pain were enrolled; 97% of them took NSAIDs for >21 consecutive days; about one-fourth of these users also received drugs for peptic ulcer and GORD (Anatomical Therapeutic Chemical code A02B). The yearly cost foran individual who uses NSAIDs for >21 consecutive days as well as concomitant GORD medications is 61.23 euros. In total, 238 subjects (8%) using NSAIDs for >21 days also received one antiplatelet agent. About 11% of subjects received opioids at least once and only 2% of them carried on the therapy for more than 90 consecutive days. In evaluating the escalation in dosage as a proxy of dependence risk, this study shows no dosage escalation in our cohort of chronic pain population - that is to say we show no risk of dependence.
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Current research suggests that inappropriate NSAID prescribing is common and needs to be addressed urgently to improve patient safety.
“Current research suggests that inappropriate NSAID prescribing is common and needs to be addressed urgently to improve patient safety [45].”
From Identification and Management of Chronic Pain in Primary Care: a Review (2016) · cites this paper as [45]
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Cites
Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment
Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006) · European Journal of Pain · doi:10.1016/j.ejpain.2005.06.009 · Cited by 5,486 · see citing works
Bhatt, D. L., Scheiman, J. M., Abraham, N. S., Antman, E. M., Chan, F. K. L., Furberg, C. D., Johnson, D. A., Mahaffey, K. W., & Quigley, E. M. M. (2008) · Circulation · doi:10.1161/circulationaha.108.191087 · Cited by 841 · see citing works
Visible small-intestinal mucosal injury in chronic NSAID users
Graham, D. Y., Opekun, A. R., Willingham, F. F., & Qureshi, W. (2005) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(04)00603-2 · Cited by 550 · see citing works
Bjordal, J. M., Ljunggren, A. E., Klovning, A., & Slørdal, L. (2004) · BMJ · doi:10.1136/bmj.38273.626655.63 · Cited by 452 · see citing works
Is the WHO analgesic ladder still valid? Twenty-four years of experience.
Vargas-Schaffer, G. (2010) · PubMed Central · Cited by 419 · see citing works
Cost of Pain Medication to Treat Adult Patients with Nonmalignant Chronic Pain in the United States
Rasu, R. S., Vouthy, K., Crowl, A. N., Stegeman, A. E., Fikru, B., Bawa, W. A., & Knell, M. E. (2014) · Journal of Managed Care Pharmacy · doi:10.18553/jmcp.2014.20.9.921 · Cited by 87 · see citing works
Polypharmacy and Chronic Pain: Harm Exposure Is Not All about the Opioids
Giummarra, M. J., Gibson, S. J., Allen, A. R., Pichler, A. S., & Arnold, C. A. (2014) · Pain Medicine · doi:10.1111/pme.12586 · Cited by 74 · see citing works
Use of Opioids and Other Analgesics by Older Adults in the United States, 1999–2010
Steinman, M. A., Komaiko, K. D. R., Fung, K. Z., & Ritchie, C. S. (2014) · Pain Medicine · doi:10.1111/pme.12613 · Cited by 74 · see citing works
Messika, J., Sztrymf, B., Bertrand, F., Billard‐Pomares, T., Barnaud, G., Branger, C., Dreyfuss, D., & Ricard, J.-D. (2014) · Journal of Critical Care · doi:10.1016/j.jcrc.2014.05.021 · Cited by 45 · see citing works
Meta-Analysis of Nonsteroidal Anti-Inflammatory Drug Use and Risk of Atrial Fibrillation
Liu, G., Yan, Y., Zheng, X., Xu, Y.-L., Lü, J., Hui, R., & Huang, X. (2014) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2014.08.015 · Cited by 45 · see citing works
Use of nonsteroidal anti-inflammatory drugs in the older adult
Fowler, T., Durham, C. O., Planton, J., & Edlund, B. J. (2014) · Journal of the American Association of Nurse Practitioners · doi:10.1002/2327-6924.12139 · Cited by 42 · see citing works
Castellsagué, J., Pisa, F. E., Rosolen, V., Drigo, D., Riera‐Guàrdia, N., Giangreco, M., Clagnan, E., Tosolini, F., Zanier, L., Barbone, F., et al. (2012) · Pharmacoepidemiology and Drug Safety · doi:10.1002/pds.3385 · Cited by 38 · see citing works
Self-citationGastrointestinal damage by non-steroidal anti-inflammatory drugs: updated clinical considerations.
Pellicano, R. (2014) · PubMed · Cited by 19 · see citing works
The World Health Organisation analgesic ladder: its place in modern Irish medical practice.
Balding, L. (2013) · PubMed · Cited by 13 · see citing works
Ye, X., Casaclang, N., & Mahmud, S. M. (2014) · Hematological Oncology · doi:10.1002/hon.2165 · Cited by 8 · see citing works
How can NSAIDs harm cardiovascular and renal function?
McDowell, K., & Clements, J. N. (2014) · JAAPA · doi:10.1097/01.jaa.0000444738.62411.83 · Cited by 7 · see citing works
Mammucari, M., Muscas, F., Arpino, G., Aronica, A., Russo, P., & Visconti, M. (2014) · Recenti Progressi in Medicina · doi:10.1701/1459.16129 · Cited by 5 · see citing works
Sanya, E. O., Kolo, P., & Makusidi, M. A. (2014) · Nigerian Medical Journal · doi:10.4103/0300-1652.129635 · Cited by 3 · see citing works
(2014) · PubMed · Cited by 3 · see citing works
Mangoni, A. A., & Knights, K. (2011) · Giornale italiano di cardiologia · doi:10.1714/643.7499 · Cited by 2 · see citing works
Les AINS sont-ils susceptibles de compromettre l’efficacité cardiopréventive de l’aspirine?
Flipo, R. (2006) · La Presse Médicale · doi:10.1016/s0755-4982(06)74941-7 · Cited by 2 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [17]Drug Allergy: Diagnosis and Management of Drug Allergy in Adults, Children and Young People National Clinical Guideline Centre (UK) 2014 9 25340226
Cited by
Sorted by citations
A Comprehensive Review of Non-Steroidal Anti-Inflammatory Drug Use in The Elderly
Wongrakpanich, S., Wongrakpanich, A., Melhado, K., & Rangaswami, J. (2018) · Aging and Disease · doi:10.14336/ad.2017.0306 · Cited by 942 · see citing works
Identification and Management of Chronic Pain in Primary Care: a Review
Mills, S., Torrance, N., & Smith, B. H. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-015-0659-9 · Cited by 216 · see citing works
Management of Osteoarthritis: Expert Opinion on NSAIDs
Magni, A., Agostoni, P., Bonezzi, C., Massazza, G., Menè, P., Savarino, V., & Fornasari, D. (2021) · Pain and Therapy · doi:10.1007/s40122-021-00260-1 · Cited by 201 · see citing works
Prevalence and characteristics of chronic pain in Brazil. A national internet-based survey study
Carvalho, R. C. D., Maglioni, C. B., Machado, G. B., Araújo, J. E. D., Silva, J. R. T. D., & Silva, M. L. D. (2018) · Brazilian Journal Of Pain · doi:10.5935/2595-0118.20180063 · Cited by 73 · see citing works
Rafaniello, C., Ferrajolo, C., Sullo, M. G., Sessa, M., Sportiello, L., Balzano, A., Manguso, F., Aiezza, M. L., Rossi, F., Scarpignato, C., et al. (2015) · Pharmacological Research · doi:10.1016/j.phrs.2015.12.026 · Cited by 63 · see citing works
Bennett, T. H., & Holloway, K. R. (2017) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2017.02.012 · Cited by 62 · see citing works
Callan, N. G. L., Hanes, D., & Bradley, R. D. (2020) · Journal of Translational Medicine · doi:10.1186/s12967-020-02569-5 · Cited by 40 · see citing works
A pilot study on the impact of known drug-drug interactions in cancer patients
Ussai, S., Petelin, R., Giordano, A., Malinconico, M., Cirillo, D., & Pentimalli, F. (2015) · Journal of Experimental & Clinical Cancer Research · doi:10.1186/s13046-015-0201-2 · Cited by 38 · see citing works
Self-citationCho, Y., Lee, S., Kim, J., Kang, J. W., & Lee, J.-D. (2018) · BMJ Open · doi:10.1136/bmjopen-2016-015461 · Cited by 33 · see citing works
Sessa, M., Sportiello, L., Mascolo, A., Scavone, C., Gallipoli, S., di Mauro, G., Cimmaruta, D., Rafaniello, C., & Capuano, A. (2017) · Frontiers in Pharmacology · doi:10.3389/fphar.2017.00305 · Cited by 29 · see citing works
Sung, W.-S., Hong, Y., Jeon, S.-R., Yoon, J., Chung, E. K., Jo, H. G., Kim, T., Shin, S., Lee, H., Kim, E., et al. (2020) · Medicine · doi:10.1097/md.0000000000022526 · Cited by 22 · see citing works
Analgesic drug use in elderly persons: A population-based study in Southern Italy
Ingrasciotta, Y., Sultana, J., Giorgianni, F., Menditto, E., Scuteri, A., Tari, M. G., Tari, D. U., Basile, G., & Trifirò, G. (2019) · PLoS ONE · doi:10.1371/journal.pone.0222836 · Cited by 22 · see citing works
Parenti, C., Aricò, G., Chiechio, S., Benedetto, G. D., Parenti, R., & Scoto, G. M. (2015) · Molecules · doi:10.3390/molecules200916758 · Cited by 19 · see citing works
Fan, J., Zhao, X., Zhao, J.-R., & Li, B.-R. (2021) · ACS Omega · doi:10.1021/acsomega.1c01167 · Cited by 18 · see citing works
Coordinate-based (ALE) meta-analysis of acupuncture for musculoskeletal pain
Ha, G., Tian, Z., Chen, J., Wang, S., Luo, A., Liu, Y., Tang, J., Lai, N., Zeng, F., & Lan, L. (2022) · Frontiers in Neuroscience · doi:10.3389/fnins.2022.906875 · Cited by 17 · see citing works
Montuori, P., Shojaeian, S. Z., Pennino, F., D’Angelo, D., Sorrentino, M., Sarno, S. D., Nubi, R., Nardo, A., & Triassi, M. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1362632 · Cited by 16 · see citing works
Lu, Y., Li, Y.-H., Huang, Y.-H., Deng, Q. C., Huang, Y., Peng, Y.-H., & Li, D. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-084500 · Cited by 13 · see citing works
Bugat, M.-È. R., Bourgouin, M., Gérard, S., Lozano, S., Bréchemier, D., Cestac, P., Cool, C., & Balardy, L. (2017) · The journal of nutrition health & aging · doi:10.1007/s12603-017-0946-8 · Cited by 10 · see citing works
Managing pain and inflammation associated with musculoskeletal disease: time for a change?
Wolfarth, B., Speed, C. A., Raimuev, K. V., Bossche, L. V., & Migliore, A. (2022) · Current Medical Research and Opinion · doi:10.1080/03007995.2022.2108618 · Cited by 7 · see citing works
Festinger, N., Smarzewska, S., Mirčeski, V., & Ciesielski, W. (2020) · Electroanalysis · doi:10.1002/elan.202060267 · Cited by 6 · see citing works
Vargas-Ruíz, R., Montiel‐Ruiz, R. M., Zamilpa, A., González‐Cortazar, M., Herrera-Ruiz, M. L., Molina-Cabrera, J., Juárez‐Aragón, M. C., & Flores‐Murrieta, F. J. (2022) · Journal of Ethnopharmacology · doi:10.1016/j.jep.2022.115756 · Cited by 5 · see citing works
Fever and breast cancer: A critical review of the literature and possible underlying mechanisms
Mehran, S., Taravati, A., Baljani, E., Rasmi, Y., & Gholinejad, Z. (2021) · Breast Disease · doi:10.3233/bd-201001 · Cited by 4 · see citing works
Ortega-Montiel, J., Montoya, A., Soria-Saucedo, R., Gallegos-Carrillo, K., Ramírez‐Palacios, P., Salmerón, J., & Salazar-Martínez, E. (2023) · Advances in Pharmacological and Pharmaceutical Sciences · doi:10.1155/2023/5555274 · Cited by 3 · see citing works
Gerdesmeyer, L., Vester, J., Schneider, C., Wildemann, B., Frank, C., Schultz, M., Seilheimer, B., Smit, A., & Kerkhoffs, G. M. M. J. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030841 · Cited by 4 · see citing works
Avilés-Herrera, J., López, G. E. Á., Déciga‐Campos, M., González-Trujano, M. E., Moreno-Pérez, G. F., Reyes‐Chilpa, R., Romero, I., Alejo-Martínez, A., & Ventura‐Martínez, R. (2025) · Molecules · doi:10.3390/molecules30153196 · Cited by 5 · see citing works
Mann, D. J., & Mattox, R. (2018) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2017.12.002 · Cited by 4 · see citing works
The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain
Sung, W.-S., Park, J. R., Park, K., Youn, I., Yeum, H., Kim, S., Choi, J., Cho, Y., Hong, Y., Park, Y., et al. (2021) · Medicine · doi:10.1097/md.0000000000024281 · Cited by 4 · see citing works
Srikrajang, S., Komolsuradej, N., Chaovalit, S., & Chuaychoosakoon, C. (2024) · Primary Health Care Research & Development · doi:10.1017/s1463423624000367 · Cited by 3 · see citing works
Managing Chronic Pain: Are Gabapentinoids Being Misused?
Anantharamu, T., & Govind, M. A. (2018) · Pain Management · doi:10.2217/pmt-2018-0018 · Cited by 3 · see citing works
Aguiñaga-Martínez, N., Zavala-Rubio, J. D. D., Ramírez-Ruíz, M., Hernández-Garza, A. J., Segura-Chico, M., la Mata-Márquez, M. J. D., & Mino‐León, D. (2024) · Gaceta Médica de México · doi:10.24875/gmm.m24000889 · Cited by 1 · see citing works
Cho, N., Choi, Y., Kim, H., Yun, J., Jun, H., Yang, C., Kim, S., & Leem, J. (2025) · Medicina · doi:10.3390/medicina61091564 · Cited by 1 · see citing works
Ampornpiriyakul, N., Komolsuradej, N., & Srikrajang, S. (2026) · BMC Public Health · doi:10.1186/s12889-026-26527-w · Cited by 1 · see citing works
Aguiñaga-Martínez, N., Zavala-Rubio, J. D. D., Ramírez-Ruíz, M., Hernández-Garza, A. J., Segura-Chico, M., la Mata-Márquez, M. J. D., & Mino‐León, D. (2024) · Gaceta Médica de México · doi:10.24875/gmm.24000025 · Cited by 1 · see citing works
Tratamiento del dolor en úlceras venosas crónicas
Imbernón‐Moya, A., de Frutos, F. J. O., Sanjuán-Álvarez, M., Portero‐Sanchez, I., Aguilar‐Martínez, A., & Gallego‐Valdés, M. Á. (2017) · Piel · doi:10.1016/j.piel.2017.03.004 · Cited by 1 · see citing works
Ortega-Montiel, J., Montoya, A., Soria-Saucedo, R., Gallegos-Carrillo, K., Ramírez‐Palacios, P., Salmerón, J., & Salazar-Martı́nez, E. (2022) · Research Square · doi:10.21203/rs.3.rs-1686514/v1 · Cited by 1 · see citing works
Ortega-Montiel, J., Montoya, A., Soria-Saucedo, R., Gallegos-Carrillo, K., Ramírez‐Palacios, P., Salmerón, J., & Salazar-Martı́nez, E. (2022) · Research Square · doi:10.21203/rs.3.rs-1686514/v2 · Cited by 1 · see citing works
Annisa, N., & Agustina, R. (2015) · Proceeding of Mulawarman Pharmaceuticals Conferences · doi:10.25026/mpc.v2i1.36
Managing chronic pain in primary care
Mills, S. E. E., & Smith, B. H. (2022) · Wiley eBooks · doi:10.1002/9781119701170.ch13
Ortega-Montiel, J., Montoya, A., Soria-Saucedo, R., Gallegos-Carrillo, K., Ramírez‐Palacios, P., Salmerón, J., & Salazar-Martı́nez, E. (2023) · Research Square · doi:10.21203/rs.3.rs-1686514/v3
Ortega-Montiel, J., Montoya, A., Soria-Saucedo, R., Gallegos-Carrillo, K., Ramírez‐Palacios, P., Salmerón, J., & Salazar-Martı́nez, E. (2023) · Research Square · doi:10.21203/rs.3.rs-1686514/v4
Shockwave in the Management of ACL Injuries: A Clinical Perspective
Zimmermann, F. J., Gaudette, L. W., Bruneau, M. M., Sellon, J. L., Gerdesmeyer, L., & Tenforde, A. S. (2026) · Applied Sciences · doi:10.3390/app16031344
Ueberall, M. A., Küster, M. A., Müller-Schwefe, P. C. G., & Müller-Schwefe, G. H. H. (2026) · Journal of Pain Research · doi:10.2147/jpr.s546747
Jabłońska, W. M., Guzik, U., & Wojcieszyńska, D. (2026) · Molecules · doi:10.3390/molecules31111828
Patient decision aids for pain medication management: A scoping review
LU, Y., Trang, N. H. H. D., Schneider, C. R., Sawan, M. J., Gnjidic, D., Reeve, E., Zadro, J. R., & Langford, A. V. (2026) · Patient Education and Counseling · doi:10.1016/j.pec.2026.109819
- Authors
- Ussai, S., Miceli, L., Pisa, F., Bednarova, R., Petelin, R., Della Rocca, G., & Giordano, A.
- Affiliations
- University of Siena (IT)
- University of Udine (IT)
- Corresponding author
- Ussai, Silvia
- Venue
- Drug Design, Development and Therapy
- Publisher
- Informa UK Limited
- Published
- 2015-04
- Volume
- 9
- Pages
- 2073
- ISSN
- 1177-8881 (ISSN-L)
- PMC
- PMC4403601
- OpenAlex
- W1996589062
- Cited by
- 44
- References
- 21
- Citations by year
- 2026: 5 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 1 · 2018: 5 · 2017: 4 · 2016: 1 · 2015: 4
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Drug Design Development and Therapy (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Institutional Research Information System (University of Udine) (submittedVersion, cc-by-nc-nd)
- TUScholarShare (Temple University) (submittedVersion, cc-by-nc)
- Use Siena air (University of Siena) (submittedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Keywords
- chronic pain, nonsteroidal anti-inflammatory drugs, inappropriate medication use, opioid use, peptic ulcer, gastroesophageal reflux disease, antiplatelet agents, drug interactions, pharmacovigilance, health care costs, dose escalation
- MeSH terms
- Adult, Analgesics, Opioid, Anti-Inflammatory Agents, Non-Steroidal, Drug Utilization, Female, Gastroesophageal Reflux, Humans, Male, Middle Aged, Peptic Ulcer, Platelet Aggregation Inhibitors, Retrospective Studies, Cohort Studies, Prevalence, Drug Costs, Endpoint Determination, Inappropriate Prescribing, Chronic Pain, Pharmacovigilance
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