Many NSAIDs are available for over-the-counter purchase, though stronger forms may require a doctor’s prescription. Some NSAIDs are available only in prescription strength. These are the most commonly used NSAIDs for chronic pain.
Over-the-Counter NSAIDs for Chronic Pain
- Aspirin (Bayer): Aspirin is one of the oldest NSAIDs and has been around for more than a 100 years. It is readily available and inexpensive. Aspirin is effective against headaches, muscle aches and pains and arthritis pain. Aspirin is also a blood thinner; many people regularly take aspirin to reduce their risk of developing clots, which can lead to a heart attack or a stroke. However, its blood-thinning action means any type of bleeding will take longer to get under control. Aspirin may irritate the stomach’s lining, though buffered forms are available to counteract this.
- Ibuprofen (Advil, Motrin): Ibuprofen is an NSAID often used to treat headaches, muscle aches and sprains (including back pain) and arthritis pain. It works by blocking certain enzymes that cause inflammation at the site of injury or irritation. Ibuprofen is generally stronger than aspirin, and is often less irritating to the stomach. However, stomach ulcers are still a potential side effect of long-term ibuprofen use. Ibuprofen is not recommended for people who have kidney or liver disease, or for those who regularly drink moderate amounts of alcohol.
- Naproxen (Aleve): Naproxen is an NSAID similar to ibuprofen. It can be used to control headaches, muscle aches and arthritis pain. If you are taking over-the-counter naproxen, however, you may take it less frequently than you would ibuprofen or aspirin. Naproxen is generally gentler on the stomach than aspirin, however prolonged use can still cause gastrointestinal (GI) distress or damage.
- Ketoprofen (Orudis): Ketoprofen is an NSAID commonly used to control both osteoarthritis and rheumatoid arthritis pain; however, it is also effective against headaches and muscle pains. Ketoprofen works much like ibuprofen and naproxen, though it may be more irritating to the stomach. Prolonged ketoprofen use can lead to kidney or liver damage, and is not recommended for people who regularly drink moderate (or more) amounts of alcohol.
Prescription NSAIDs for Chronic Pain
- Meloxicam (Mobic): Meloxicam is a prescription NSAID that is often used to treat arthritis pain, including osteoarthritis and rheumatoid arthritis. Meloxicam is gentler to the stomach than most other NSAIDs, including ketoprofen, which is often used for the same diagnoses. However, regular meloxicam use may still put you at risk for GI distress.
- Celecoxib (Celebrex): Celecoxib is a prescription NSAID that helps control joint and arthritis pain, muscle aches and pains and pain associated with inflammation. Like meloxicam, it is one of the gentler NSAIDs for your stomach; however, prolonged celecoxib use may still lead to ulcers and GI bleeding. There is also some risk of cardiovascular events for people who take celecoxib for a long time, such as a heart attack or stroke.
NSAID Safety and Chronic Pain
All NSAIDs for chronic pain, including those purchased over-the-counter, now include FDA warnings for their potential complications. Despite this, they continue to be one of the most popular classes of drug used to treat chronic pain.
Prescription NSAIDs for chronic pain may be recommended for long-term use if someone has an increased risk for GI complications. These individuals include seniors, and anyone with a history of ulcers or other bleeding complications.
If you take NSAIDs for chronic pain, don’t be surprised if your doctor regularly checks your blood. Potential NSAID toxicity can be avoided by monitoring both your blood count and your creatine levels. If your levels seem off, your doctor may change your medication or prescribe additional drugs to counteract any potential complications.
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 Merck Manuals Online Medical Library. Pain: Treatment. Accessed 6/21/09. http://www.merck.com/mmhe/sec06/ch078/ch078d.html
Patino FG, Olivieri J, Allison JJ, Mikuls TR, Moreland L, Kovac SH, Juarez L, Person S, Curtis J, and Saag KG. Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices. Journal of Rheumatology. 2003 Dec;30(12):2680-8
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