Dr. Lee: I gather you mean that the COX-2 inhibitors generally have less stomach side effects than the traditional NSAIDs. But how about pain and inflammation relief? Are they just as good, better, or worse than traditional NSAIDs?

Dr. Shiel: The selective COX-2 inhibitors have been shown to be equally effective as the traditional NSAIDs. This means that they have been shown to be as potent as traditional NSAIDs in relieving pain and inflammation.

Dr. Lee: How do you decide when to use a COX-2 inhibitor and when to use a non-selective traditional NSAID in treating your patients with arthritis?

Dr. Shiel: It is important to understand that selection of anti-inflammation medicines for arthritis has to be individualized. The doctor must consider the type and severity of the arthritis, patient's age, prior side effects and responses to different NSAIDs, as well as any co-existing medical conditions such as heart, kidney, and liver disease.

After making the proper selection, the doctor will try to use the lowest effective dose of the medicine in order to minimize risks and side effects.

For example, if a patient has a history of ulcer bleeding and needs long term NSAIDs, I would prefer to use the selective COX-2 inhibitor Celebrex. Alternatively, I will consider combining a traditional NSAID with Prilosec or Cytotec, medications that can protect the stomach from ulcerations.

Dr. Lee: In your experience Bill, how effective are NSAIDs in reducing pain, inflammation and helping your patients function?

Dr. Shiel: In my patients with arthritis and chronic inflammation, NSAIDs can be critical to maintain daily functions and sense of well being. Many of my patients report significant flare of pain and arthritis if they miss just one dose. NSAIDs are essential part of treatment of the inflammation of chronic arthritis.

Dr. Lee: What happens when NSAIDs don't do the trick, and the pain and the inflammation persists?

Dr. Shiel: In the setting of intense pain or persistent pain, in patients who are already taking NSAIDs, we can supplement with short-term narcotic pain relievers. The reason we prefer to use narcotics short-term is because narcotics have the potential for habituation, which means the patient may require higher and higher doses for pain relief, and that they become habit forming.

Dr. Lee: What are some of the examples of narcotic pain relievers that you use?

Dr. Shiel: Typical narcotic pain relievers that we use include Codine or Codine derivatives and Darvocet or related medications to Propoxaphine and Ultram.

Dr. Lee: Thank you, Bill, for sharing with us your perspective on proper use of pain relievers in your practice and also for reviewing the use of over-the-counter pain relievers.

Dr. Shiel: Thank you Dennis for your questions.

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