Table 2.

Limitations of pharmacologic therapy for chronic pain

Therapeutic class	Major limitations
Nonselective NSAIDs	Risk for gastrointestinal toxicitya
	Recommended use of concomitant gastroprotective agents
	increases costa
	Risk for renal toxicitya
	Cardiovascular safety issuesb
COX-2 Inhibitors	Increased risk
	Cardiovascular safety issuesc
	Renal toxicitya
Opioids	Associated with: Reduced cognitive and motor functiond
	Respiratory depressione
	Fear of dependence/tolerance/abusef
	Stringent regulatory requirements and potential for scrutiny maylimit adequate prescribingf

^aNotes: ACR 2000

^bHudson et al. 2005

^cCaldwell et al. 2006

^dJCAHO 2001

^eStephens et al. 2003

^fWeinstein et al. 2000.

Abbreviations: COX-2, cyclooxygenase-2; NSAIDs, nonsteroidal antiinflammatory drugs.