best NSAIDs

NSAIDs For Inflammation And Pain Relief

/ Thomas Cohn, MD

NSAIDS pain pillsNonsteroidal anti-inflammatory drugs (NSAID) are the most commonly prescribed drugs in the world. Generally they are safe medications and they are often available as over-the-counter (OTC) items. The risks and benefits of these drugs are often misunderstood. Taking too much is common; not taking enough to be effective may also be an issue. The directions on how to take the drugs do vary depending on the exact compound. Furthermore, every drug has different strength, so a small amount of one drug could be stronger than a big pill of another one. Lastly, some drugs have unique delivery systems, such as they are available in creams to put on the skin.

Understanding NSAIDs

Medications like aspirin, ibuprofen, naproxen and diclofenac are the most common NSAIDs that are used and available OTC. Acetaminophen (Tylenol) is not a NSAID since it does not have any anti-inflammatory activity. NSAIDs inhibit cyclooxygenase (COX) enzymes, and these affect the making of certain prostaglandins and thromboxanes, leading to their anti-inflammatory abilities.

Inflammation is a cause of pain in many ailments, like osteoarthritis, rheumatoid arthritis, headaches, low back pain, and many causes of muscle and joint pain. Using a medication that blocks inflammation therefore often diminishes pain. If one has ongoing muscle or joint pain, these medications may be helpful. If your pain is due to nerve damage or irritation, like a disc bumping a nerve, or nerve trauma and damage, NSAIDs often do not help. Some of these NSAIDs come in crèmes, especially aspirin, and diclofenac, and using them on painful muscles and joints every four hours as needed can be extremely helpful with little or no risk overall to your health.

NSAID Risks

These medications have been thought to increase the risk of heart disease, especially the risk of a heart attack or stroke. Vioxx was an anti-inflammatory that was pulled from the market because it did increase the risk of heart attacks. Celebrex is very similar to Vioxx in how it works and there was concern it had some of the same risks related to heart attacks. Ibuprofen, aspirin, and naproxen are not as selective for just inflammation as Celebrex and have been found not to increase heart attack risk. In November 2016, a huge study reported that looked at the risk of Celebrex compared to the other NSAIDs and found the risk to be fractionally less. The overall risk for taking an NSAID is 0.7% for having a cardiovascular event. What this means is the risk for heart attacks while taking any of these medications is very low.  

The most important risks of this class of drugs are the affects on the stomach, kidney, and on hypertension. Nonsteroidal anti-inflammatory drugs as noted above affect prostaglandins and thromboxane, and these compounds in the body can affect bleeding and blood clots. Taking NSAIDs can irritate the stomach causing pain and bleeding, if this happens, the medications should be stopped and your doctor told about the symptoms. If one is taking a medication to thin blood to prevent a blood clot, an NSAID or aspirin can make one prone to bleeding problems and should also not be taken. The changes in prostaglandins caused by the NSAIDs can affect how well the kidneys work, as one gets older, the kidney function may naturally be diminished and these drugs can cause the kidneys to fail. The affect on the prostaglandins also impacts blood pressure in some people. If you have hypertension, these can make the problem worse and may need to be stopped or changed to a different NSAID. In general, these medications do not affect the liver and do not cause liver damage. There are other reactions to NSAIDs but these are less common, if they seem to be causing some sort of medical problem, talk to your doctor.

Nonsteroidal Anti-inflammatory Drugs And Safety

/ Thomas Cohn, MD

Are NSAIDs safe?The FDA recently ruled that available evidence does not prove that the painkiller Naproxen, often sold under the name Aleve or Naprosyn, is linked to greater reduction in heart disease than other nonsteroidal anti-inflammatory drugs (NSAIDs) on the market. A previous study suggested Naproxen was less dangerous to the heart than NSAIDs like Ibuprofen or Celebrex, but the FDA advisory panel did not find enough evidence to corroborate the statement.

The science of nonsteroidal anti-inflammatory drugs (NSAID) like Ibuprofen, Naproxen, and Celebrex is quite complex. The mechanism and effect on the heart attack risk is not really fully understood. These drugs reduce inflammation in the body by blocking enzymes known as COX-1 and COX-2. The newer drugs in this group were a bit more selective in blocking COX-2 enzymes, which led to a reduction in stomach discomfort. However, the overall effect of all these drugs is that they may disrupt the balance of other enzymes in the inflammatory cycle throughout the body and actually lead to more hardening of the arteries and an increased risk of heart attack and stroke. That said, the increased risk is similar to the risk of a poor diet, smoking, genetics, and diseases like diabetes.

The risk of all NSAID medications seems to be that they may increase the risk of hardening of the arteries and heart attack or stroke. The newer COX-2 drugs like Celebrex, and previous ones Vioxx and Bextra, made this more evident since they became very widely used. Once the effect was found with the more selective COX-2 drugs, further studies have shown all these medications have the same potential risk.

NSAID Use In America

The use of NSAIDs is widespread. The medications can be very helpful in controlling pain related to injury and chronic inflammation due to degeneration of joints and neck and back problems. Many people do take these medications on a long-term basis to control pain levels. These medications can be taken fairly safely, but knowing that they can cause problems, a person should work at reducing all their other risks to prevent heart issues.

The main issue with NSAID medications is not heart attacks with most people, but stomach irritation and bleeding and kidney injury. All these drugs are very well known as significant causes of gastrointestinal bleeding due to the enzyme affects of the COX system on the lining of the stomach. Severe bleeding is a common side effect from these drugs. The COX enzymes and other affected enzymes also can lead to damage to the kidneys. In reality, these drugs have hurt more stomachs and kidneys than caused heart attacks.

The take home message on all medications is that any drug has risks and can have bad side effects on the body. Whenever taking a medication, one has to decide whether the benefit going to outweigh the risk. If you can change your lifestyle such that a drug is not needed, that would be the best option. If changing your lifestyle options is not sufficient, then discussing the risks and benefits with your healthcare provider is the next step with regards to any medication.

Related source: Reuters