Pain management and beyond: evolving concepts and treatments involving cyclooxygenase inhibition.

Chronic uncontrolled pain may be the greatest health care crisis facing the United States. It is the major symptom for which patients seek medical care and is associated with substantial economic and psychosocial costs. For many patients, particularly the elderly and those suffering from cancer, chronic pain is often undertreated. Because pain has an emotional component and is frequently accompanied by depression and/or anxiety, patients benefit from a comprehensive assessment and multidisciplinary approach to treatment. It is likely that coxibs (cyclooxygenase or COX-2-selective inhibitors) will assume an increasingly prominent role in the treatment of chronic pain associated with arthritis, cancer, and other diseases either as monotherapy or in combination with other drugs. In addition, the role of COX-2 inhibition in the prevention and treatment of colon cancer, Alzheimer's disease (AD), and other chronic health problems is an area currently undergoing intense investigation.