Non-steroidal anti-inflammatory drugs (NSAIDs) such as diclofenac, ketorolac, tenoxicam, flurbiprofen, etc., are generally used to relieve pain in biliary colic.
Characteristics of studies
We searched for randomized clinical trials involving people who had gallstones and compared NSAIDs to no intervention, placebo, or other drugs.
We included 12 randomized clinical trials with 828 participants, of which 416 received NSAIDs and 412 received placebo, or antispasmodics, or opioids. Given the widespread occurrence of biliary colic, these numbers of trials and participants are inadequate. In these trials, elderly participants and participants with concomitant diseases were poorly represented. Twenty-four percent of the participants were men. The age of participants ranged from 18 to 86 years. All people were hospitalized in the emergency room with acute biliary colic (pain). Mortality was not. None of the studies included reported quality of life. We found that NSAIDs significantly reduce biliary pain (pain in biliary colic) compared with placebo and spasmolytic drugs. NSAIDs also significantly reduced the risk of complications associated with cholestasis congestion of bile (e.g., acute cholecystitis, acute pancreatitis, jaundice, cholangitis), compared with placebo and antispasmodics. In one study, NSAIDs were compared with opioids and reported complications: the authors did not find any significant differences between treatment options.
None of the studies reported serious adverse events. Seven of the 12 trials reported minor adverse events; in two of the eight studies, no adverse events were observed, and minor events were reported in the remaining five studies.
We found one ongoing randomized clinical trial aimed at assessing the analgesic effect of intravenous ibuprofen in biliary colic.
The trials were free of sponsorship of the pharmaceutical industry or another type of support by commercial organizations that could manipulate the design of a clinical trial, its conduct, results or conclusions.
Quality of evidence
The quality of evidence by GRADE criteria (a system designed to classify rank evidence and recommend health care) was average for comparing NSAIDs with placebo on outcome no relief of pain, and the quality was low or very low for other outcomes and comparisons.
Only one of the 12 trials had a low risk of bias, by the predetermined sections (domains) of the “Bias Risk” estimate.
The results of this systematic review with meta-analysis suggest that NSAIDs can be used to relieve pain, but further randomized clinical trials are warranted, and NSAIDs should be used with caution in some patient groups such as the elderly and people with concomitant diseases.
Treatment of pain in joints with drugs
In the practice of treating pain in the joints, regardless of the nature and nature of the pain, non-steroidal anti-inflammatory drugs (NSAIDs) are most often used. In this article, we have prepared a brief review of four drugs for the treatment of pain in various pathologies of the musculoskeletal system. The drugs will be listed in order of the degree of decrease in their analgesic properties.
Among the main advantages of using these drugs should be:
- Ability to relieve pain;
- Ability to relieve edema;
- Ability to relieve hyperemia and hyperthermia;
- Reduction of inflammatory processes in tissues.
At the moment, the world pharmaceutical industry produces about 40 names of such drugs, which are divided into subgroups. The vast majority of them are derivatives of various acids (acetylsalicylic, propionic, indole, aminoacetic).
Side effects of drugs from the NSAID group
Side effects from the use of drugs for the treatment of pain in the joints are predetermined by the fact that almost all of them are derivatives of various organic acids. And this, in turn, cannot but lead to the development of such states as:
- irritation and ulceration of the gastrointestinal tract;
- oppression hematopoietic function;
- allergic reactions;
- violation of the nervous system;
- violation of renal blood flow.
But do not think that such conditions can develop in everyone who is going to treat pain in joints with drugs from the NSAID group. Everything in this world is individual, as well as individual reaction to the use of anti-inflammatory non-hormonal drugs. Modern doctors are aware of the possibility of developing side effects from these drugs and therefore try to assign them short courses, and when a certain therapeutic effect is achieved, dosages are reduced or they replace the use of one form of the drug (usually injections of solutions) with another form (suppositories, ointments, pills).