NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin, are the most widely used pain medications. Traditionally these medications are considered to be weak analgesics and have been used extensively for headaches, arthritis and a wide range of minor aches and post-surgical conditions.

NSAIDs are powerful inhibitors of prostaglandin synthesis through the effect on cyclooxygenase (COX). Prostaglandins are not thought to be important pain mediators, but they do cause hyperalgesia by sensitizing peripheral nociceptors to the effects of various mediators of pain and inflammation, such as somatostatin, bradykinin, and histamine. Thus, NSAIDs are used primarily to treat pain that results from inflammation and hyperalgesia. The table below presents the commonly used NSAIDs.

Acetaminophen is not strictly an anti-inflammatory medication. Its peripheral and antiinflammatory effects are weak. However, it shares many properties of NSAIDs. The medication readily crosses the blood-brain barrier. Its action resides primarily in the central nervous system, where prostaglandin inhibition produces analgesia and antipyresis.

Side Effects of NSAIDs

Common side effects of NSAIDs include gastrointestinal toxicity, stomach ulcers, and gastric bleeding. Inhibition of platelet cyclooxygenase can result in decreased hemostasis and surgical bleeding. Renal dysfunction can occur with prolonged and excessive use of NSAIDs. Particularly at risk from excessive use of NSAIDs are the elderly, patients with renal dysfunction, congestive heart failure, ascites, or hypovolemia. Patients treated with nephrotoxic drugs such as aminoglycosides are also at significant risk. Other adverse effects of NSAIDs include hepatic dysfunction or necrosis, asthma, vasomotor rhinitis, angioneurotic edema, urticaria, laryngeal edema or even cardiovascular collapse.

Cardiovascular risks of NSAIDs, especially COX2 inhibitors, have become a major focus of attention recently. Suggestions that the use of COX2 inhibitors may decrease prostacyclin (PGI2) levels with relatively unopposed platelet thromboxane A2 generation may lead to increased thrombotic risk have cautioned against the use of such agents. There is strong clinical evidence that rofecoxib (Vioxx) is associated with increased cardiovascular risks, which resulted in the withdrawal of this medication from market. Recent studies show inconsistent results with regards to the cardiovascular risks for celecoxib. Until now the experimental and clinical data are quite discordant regarding the cardiovascular hazard from the administration of naproxen and other NSAIDs. In the absence of clear-cut data, physicians will have to use traditional NSAIDs (or coxibs) in patients with high cardiovascular risks on the basis of their common sense rather than on evidence-based medicine.

Meet the FLPNR Team

  • YiLi Zhou, M.D., Ph.D
  • Hoang (Wayne) T. Vu, D.O.
  • Lourdes Varela–Batista, M.D.
  • Vinh-Loc Nguyen, P.A.
  • Kirstie Nicol, P.A.
  • Irene Aponte Moreno, N.P.
  • Sunny Park, N.P.
Neurologist in Ocala, FL Doctor of Osteopathic Medicine in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Physician in Ocala, FL Nurse Practitioner in Ocala, FL Nurse Practitioner in Ocala, FL
Neurologist in Ocala, FL

YiLi Zhou, M.D., Ph.D.

Harvard-Trained, Board-Certified Pain Specialist and Neurologist.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Doctor of Osteopathic Medicine in Ocala, FL

Hoang (Wayne) T. Vu, D.O.

Dr. Zhou graduated from Wenzhou Medical College, China in 1982 with training in both modern western medicine and traditional Chinese medicine. He had neurology fellowship training at Shanghai Medical School, specializing in EMG/NCV and evoked potential studies. He served as an attending neurologist in China.

Physician in Ocala, FL

Lourdes Varela–Batista, M.D.

Dr. Varela is a fellowship trained pain specialist and board certified PMR expert. Her specialities include physical medicine and rehabilitation and interventional pain medicine. She received her undergraduate degree from University of Puerto Rico and completed her medical degree from New York Medica College. Dr. Varela completed her physical medicine and rehabilitation residency at University of Texas Health Science Center San Antonio.

Physician in Ocala, FL

Vinh-Loc Nguyen, P.A.

Vinh-Loc Nguyen is a NCCPA certified physician assistant and is licensed by the State of Florida Department of Health. He received his Bachelor of Science degree in microbiology and Bachelor of Arts Degree in economics from University of Florida in 1994. He had a successful career in the financial industry before returning to his true passion for medicine.

Physician in Ocala, FL

Kirstie Nicol, P.A.

Kirstie has been serving as a physician assistant at Florida Pain and Rehabilitation Center, Lake City since September 2016. She is board certified by the National Commission on Certification of Physician Assistants (NCCPA). She received her master of science in physician assistant studies, at Clarkson University in Potsdam, NY.

Nurse Practitioner in Ocala, FL

Irene Aponte Moreno, N.P.

Ms. Irene Aponte Moreno is an Adult-Gerontology certified Nurse Practitioner and licensed by the State of Florida Department of Health. In 2014, she received her Master of Science degree in Nursing from the University of South Alabama. She completed her Bachelor of Science degree in Nursing from Jacksonville State University in December of 2006. In 2003, she received an Associates of Arts degree from Southwestern Michigan College. She also completed an Associate degree in Informatics from the University Institute Antonio Jose de Sucre located in Lara State, Venezuela.

Nurse Practitioner in Ocala, FL

Sunny Park, N.P.

Ms. Sunny Park is an AANP and ANCC certified Advanced Registered Nurse Practitioner, licensed by the State of Florida Department of Health. She graduated with Summa Cum Laude with Bachelor of Arts in Drawing from Southern Illinois University in 1999. She pursued nursing career and graduated with Associate of Science in Nursing in 2007 and started working as a registered nurse in Cardiovascular ICU in St.Luke’s Medical Center. She continued with her education and graduated with Magna Cum Laude obtaining Bachelor of Science in Nursing in 2010 from Cardinal Stritch University. During her nursing education, she was awarded multiple scholarships including the Lamplight scholarship by Milwaukee Nurses Association.

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