Chronic NSAID use is now one of the most common causes of progressive kidney disease [Advisor Forum, “Non-narcotic analgesics for musculoskeletal pain,” April 2016]. As a nephrologist, half of my referrals are because of long-term, standard-dose NSAIDs.—JACK MONCRIEF, MD, Austin, Tex. (211-1)
I suggest looking carefully at the literature supporting salsalate as first-line analgesic therapy given:
- its endorsement by the American Heart Association as a “first-line” analgesic in 2007
- its effect on metabolism and diabetes—it lowers A1c levels and probably lowers insulin resistance, and it has positive lipid panel effects
- its effect on the stomach—ie, does it cause significant GI bleeds; or, can it even be used in patients who have had GI bleeds from other NSAIDs?
- its blood level can be monitored (via salicylate levels)
- its non-effect on platelet aggregation inhibition
- its location in a non-Cox-1 and non-Cox-2 category of NSAIDs
—CHARLES BEAUCHAMP, MD, PhD, Ahoskie, N.C. (211-2)
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I advise patients with musculoskeletal pain to ALTERNATE acetaminophen with an NSAID, thereby producing synergistic pain relief, while reducing the risks of overdosing.—WILLIAM TWEEDDALE, RPA-C, Kingston, N.Y. (211-3)
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