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    1. Pain is an unpleasant sensation localized to a part of the body. It is often described in terms of a penetrating or tissue-destructive process (e.g., stabbing, burning, twisting, tearing, squeezing) and/or of a bodily or emotional reaction (e.g., terrifying, nauseating, sickening). Furthermore, any pain of moderate or higher intensity is accompanied by anxiety and the urge to escape or terminate the feeling. These properties illustrate the duality of pain: it is both sensation and emotion. When it is acute, pain is characteristically associated with behavioral arousal and a stress response consisting of increased blood pressure, heart rate, pupil diameter, and plasma cortisol levels. In addition, local muscle contraction (e.g., limb flexion, abdominal wall rigidity) is often present.

      Cox-1 is constitiutionally expressed. Cox-2 is for inflammation.

      Cox-2 inhibitors reduce gastric side effects, increase MACE, similar kidney outcomes.

      The Increased MACE may be a class effect (except aspirin), and should be avoided post PCI and post bypass/ and in elderly at risk.