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Experts: COX-2s still have role in pain care

Meanwhile, a study suggests that directly tackling pain might do more than just make a patient feel better for the moment.

By Victoria Stagg Elliott, amednews staff. April 10, 2006.

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Physicians should not be reluctant to use COX-2 inhibitors to treat pain in the short term, and they might be able to promote faster healing by addressing pain quickly and dealing with any underlying depression. These were the findings of several presentations at the annual meeting of the American Academy of Orthopaedic Surgeons last month in Chicago.

Controversy over COX-2 inhibitors broke in the fall of 2004 with the release of data linking long-term use to an increased risk of heart attack and other cardiovascular events. Two drugs in this class, rofecoxib and valdecoxib, were withdrawn from the market, and many patients who had been using them for chronic conditions were switched to other drugs.

Experts say, however, that this kind of drug still has a significant role in managing acute pain, particularly that associated with surgery.

"There's no evidence that short-term use really has any significant cardio-toxicity," said Thomas A. Einhorn, MD, chair of the Dept. of Orthopedic Surgery at Boston University School of Medicine. He moderated a panel on COX-2 inhibitors and nonsteroidal anti-inflammatories.

A growing body of evidence also shows that failing to control a patient's pain adequately might translate to more than just a bad experience for the patient. It might cause slower healing and a lower level of function over the long haul. For example, one study found that patients receiving a total knee or hip replacement who received aggressive pain control during and after the surgery were more likely to achieve an early recovery. They also were more likely to describe their recovery as easy and had little or no pain by the end of six weeks.