Opioids NSAID compared

Apart from their anti-inflammatory activity the NSAIDs also show, dependent on the condition and the type of pain, considerable analgesic efficacy. In some forms of postoperative pain the NSAID s can be as efficacious as opioids, especially when prostaglandins, bradykinin and histamine, which are released by inflammation, have caused sensitization of pain receptors to normally painless stimuli. In Table 4 some advantages and disadvantages of NSAID s and opioids are compared. Although analgesic effects at peripheral or central neurons cannot be excluded completely, most studies indicate that... 

Tramadol and non-steroidal anti-inflammatory drugs have been compared in two studies of patients with joint pain associated with osteoarthritis (8,9). In an open, randomized study 60 patients with osteoarthritis taking NSAIDs were given either modified-release tramadol 100 mg 8-hourly or modified-release dihydrocodeine 60 mg 8-hourly for 4 days the controls were 30 patients who took an NSAID alone (8). Both opioids provided adequate analgesic adjuncts to NSAIDs, but tramadol caused significantly more minor initial adverse effects. 

As an NSAID, diclofenac is easy to use, and has been shown to be efficacious in arthritic syndromes, as well as for acute treatment of migraines, and small procedures. A major advantage of diclofenac, as with other NSAIDs, is its use in multimodal analgesia. In patients who are post-operative or with certain chronic pain syndromes, diclofenac can be used to provide additive analgesia and an opioid-sparing effect. Diclofenac has decreased side effects when compared to opioids in terms of nausea, respiratory depression, sedation, and constipation. 

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