The American Pain Society (APS), the leading US professional organization devoted to pain management, recently released the first evidence-based, multidisciplinary guideline for treating acute and chronic arthritis pain.
The full text of the APS guideline is available at www.ampainsoc.org/pub/ arthritis.htm. It strongly emphasizes that arthritis pain is best treated through a combination of ongoing pain assessment, medication, proper nutrition, exercise, and patient and family education.
? For mild-to-moderate pain?acet-aminophen is the drug of choice because of its mild side effects, wide availability, and low cost.
? For moderate-to-severe pain?cyclooxygenase-2 (COX-2) non-steroidal anti-inflammatory drugs (NSAIDs), such as Celebrex and Vioxx, are the drugs of choice for their pain-relieving potency and absence of gastrointestinal (GI) side effects.
? If the patient fails to respond to acetaminophen and COX-2 drugs, nonselective NSAIDs should be considered, but only if the patient is not at risk for NSAID-induced GI side effects.
? For severe arthritis pain for which COX-2 drugs and nonspecific NSAIDs do not provide substantial relief, opioid medications, such as oxycodone and morphine, are recommended
One study linked multiple pregnancies to an increased risk of developing atrial fibrillation later in life, and another investigated the association between premature delivery and cardiovascular disease.
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