What are NSAIDs?
Nonsteroidal anti-inflammatory drugs, or NSAIDs, are pain medications often used to treat muscle and joint pain, though they may be used for nerve pain in some cases. NSAIDs fall under the heading of non-opioid analgesics, or non-narcotic pain medications. Typically, using NSAIDs for chronic pain is most effective when your pain is mild or moderate.
Unlike opioids, many NSAIDs can be purchased over the counter. Ibuprofen and naproxen, both NSAIDs, are readily available in drug and convenience stores. Prescription-strength NSAIDs for chronic pain are also available if your pain is more severe. In these cases, NSAIDs may also be combined with opioids to better control your pain.
How NSAIDs Relieve Pain
NSAIDs reduce pain in two ways. First, they alter the sensation of pain by blocking certain enzymes that participate in the pain response. Second, they work to reduce swelling that is often associated with certain types of pain. Some NSAIDs, however, are only effective at reducing swelling when taken at higher doses.
Most NSAIDs are taken by mouth. NSAID strength varies depending on the type of medication and dosage used. When you take NSAIDs for chronic pain, you may take a short-acting version combined with a long-acting pain medication, such as an opioid or an adjuvant analgesic (an anticonvulsant or an antidepressant). This is especially true if you have breakthrough pain. However, a long-acting NSAID for chronic pain may be enough to control your symptoms.
Types of NSAIDs for Chronic Pain
Some of the more commonly available over-the-counter NSAIDs for chronic pain include aspirin, ibuprofen, naproxen and ketoprofen. These pain medications are sold in different non-prescription strengths, and may be combined with other ingredients such as caffeine or acetaminophen.
Prescription strength versions of NSAIDs are available as well. Some commonly used prescription NSAIDs for chronic pain include meloxicam and celecoxib. Nearly all NSAIDs, both prescription and over the counter, are taken orally.
NSAID Precautions – Are NSAIDs Safe for Chronic Pain?
When NSAIDs are used regularly over an extended period of time, as is often the case with chronic pain, the potential for side effects increases. Evidence suggests that the potential for NSAID-associated complications increases as you get older. Some more common side effects include:
- Stomach irritation and ulcers
- Gastrointestinal (GI) bleeding
- Increased potential for bruising
- Exacerbation of asthma symptoms
- Increased risk of stroke, heart attack and blood clots
If you plan to be on NSAIDs for chronic pain long-term, your doctor may alter the dosage. He may also provide you with other prescription medication that offsets the potential for developing any of the above conditions, such as misoprostal. The potential for NSAID complications may be increased if you:
- Smoke
- Drink alcohol regularly
- Are a senior
- Have a history of heart disease
- Have high blood pressure
- Have ever had any GI problems
- Have kidney or liver disease
All NSAIDs, both prescription and over the counter, now sport warning labels thanks to a ruling by the Food and Drug Administration. Despite the warnings, using NSAIDs remains one of the most popular ways to relieve pain.
Sources:
American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. Accessed 6/21/09. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf
The American College of Gastroenterology. The Dangers of Aspirin and NSAIDs. Accessed 6/21/09. http://www.acg.gi.org/patients/women/asprin.asp
The Merck Manuals Online Medical Library. Pain: Treatment. Accessed 6/21/09. http://www.merck.com/mmhe/sec06/ch078/ch078d.html
The U.S. Food and Drug Administration. COX-2 Selective (includes Bextra, Celebrex, and Vioxx) and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Accessed 6/21/09. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm103420.htm
