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Nonsteroidal antiinflammatory analgesics (NSAIAs) are a group of pharmaceutical agents that possess both analgesic and antiinflammatory properties. The NSAIAs are frequently used in human and veterinary medicine to relieve mild, moderate and severe pain associated with surgery, inflammatory conditions, and osteoarthritis.
The efficacy of many NSAIAs are equal or superior to the pure μ-opioid agonists (e.g., oxymorphone, morphine, hydromorphone, meperidine), and butorphanol or buprenorphine in managing postoperative pain.
When used in combination with opioids, a synergistic effect is achieved and may allow for reduced dosing of the opioid in mild to moderate, but not in severe, pain states where higher opioid dosages may still be necessary. In addition to their centrally acting antinociceptive effect, NSAIAs concentrate in inflamed joints and tissues with a duration of effect of 12 to 24 hours.
The duration and efficacy of the NSAIAs make them ideal for treating acute and chronic pain in veterinary patients; however, because of their potential for harm, patient and NSAIA selection must be considered prior to administration. More detailed reviews of NSAIAs have been published elsewhere. .
Signs of Gastric Ulceration
Clinical signs of gastric ulceration in patients include vomiting, hematemesis, melena, abdominal pain, pallor of the mucous membranes, lethargy, weakness, collapse and anorexia. Interestingly, experimental studies of NSAIAs reported clinical signs of gastric ulceration to be inconsistently present in patients with endoscopic or gross evidence of gastrointestinal lesions.
Some patients remained bright and alert with no signs of abdominal pain. These findings are consistent with reports in humans where most cases of NSAIAinduced gastric ulceration go undiagnosed until they are lifethreatening, complicated ulcers. The delay between the development of gastric ulceration and the observation of clinical signs may be related to unique properties of the NSAIA, or clinical signs may not develop until a deep ulcer erodes into a large blood vessel.
Poor correlation between gastrointestinal lesions observed by endoscopy and clinical signs following treatment with carprofen, ketoprofen, or meloxicam have been reported in other studies. These lesions were mild to moderate in severity and did not differ statistically from placebo. The initial signs of vomiting and anorexia are frequently due to gastric irritation or inflammation. Because of the requirement of a severe lesion prior to the presence of hemorrhage or acute kidney injury, it is essential that owners be warned to stop NSAIA administration and seek immediate advice from the family veterinarian should the patient or cat develop vomiting or anorexia.