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Which NSAID is correct for you? Here's what you need to know

March 19, 2024 – Terry Spearman isn't any stranger to pain.

Last 12 months, Spearman, 68, needed to have a knee substitute after experiencing pain and swelling in her knee as a consequence of osteoarthritis.

She was prescribed nonsteroidal anti-inflammatory drugs, also called NSAIDs. to take care of their pain.

She took a round of Celebrex after which Meloxicam, each prescription NSAIDs. They are barely stronger than the common over-the-counter medication and he or she said these medications helped her get used to her recent knee.

NSAIDs are a category of medicines used to alleviate pain, fever, and inflammation. The commonest NSAIDs that will be easily purchased are ibuprofen equivalent to Advil and Motrin; Naproxen, also generally known as Aleve; and aspirin. (Aspirin is technically an NSAID and is just not typically really useful for pain relief.)

They can be found in tablets, capsules, topical gels, and creams. Topical NSAIDs equivalent to Aspercreme, Salonpas, and Voltaren are used to treat osteoarthritis pain and soft tissue injuries.

Studies show that greater than 30 million Americans usually use NSAIDs to treat pain. According to a 2022 study45% of U.S. adults reported currently using it. While these medications can work wonders for pain relief—they can assist treat every part from the pain and swelling Spearman experienced to common headaches—they're not all the identical, and there are some serious risks when overused Health risks. Experts urge consumers to make use of these drugs sparingly; Side effects have l Ed to 100,000 hospital admissions and 17,000 deaths per 12 months.

“I am now cautious about continued use of these medications, particularly Advil or Meloxicam, just because I know long-term use can affect the kidneys,” Spearman said. “During my last physical exam, I found that my creatinine levels were elevated and there was a suggestion that this may be related to taking NSAIDs.”

Read on to learn how one can manage these commonly used medications.

Acetaminophen vs. NSAIDs and more

A typical misconception is that Tylenol (acetaminophen) is an NSAID. It is just not. Although it relieves pain and reduces fever, it doesn't relieve inflammation. Typically, acetaminophen doesn't cause as many problems in your gut as NSAIDs.

Kristine Keaton, PharmD, is a clinical pharmacist in rheumatology on the Cleveland Clinic. She said NSAIDs are the primary selection for any pain that's inflammatory in nature.

They are working on what are called COX enzymes or cyclooxygenase enzymes, she said.

“These are proteins in the body that are involved in the major signaling pathway that is responsible for triggering inflammation and telling your body that you are in pain,” she explained. “By blocking this specific protein or enzyme, we block the production of chemicals that signal that you are in pain and then reduce the inflammation that is causing that pain in the first place.”

People react in a different way to different NSAIDs, Keaton said.

“We don't really know why, but we do know that some patients may respond better to one than the other. So it might be a trial and error thing to figure out which one you think works best,” she said.

The predominant difference between naproxen and ibuprofen is that naproxen is longer acting and only two doses are really useful every 12 hours each day.

“It is often a better choice if patients are taking NSAIDs chronically under the direction of their doctor and know they need around-the-clock pain relief,” Keaton said.

She noted that ibuprofen is a shorter-acting medication that will be taken every 4 to six hours and is usually the primary selection for fast-acting relief of acute pain. Typically, she said, those taking NSAIDs shouldn't use them for greater than three days for fever and 10 days for treating pain equivalent to muscle aches.

“At this point, you should probably talk to your doctor to make sure there are no concerns about taking an NSAID for a long time,” Keaton said.

Nilanjana Bose, MD, is a rheumatologist at Lonestar Rheumatology in Houston. Her clinic treats patients with arthritis and other diseases of the joints, muscles and bones, including inflammatory and autoimmune diseases. She said although the list for NSAID use is infinite, caution must be exercised.

“These are not safe medications. These are toxic, potentially dangerous medications. They are effective but must be used with caution and appropriate monitoring,” she warned.

“Your blood pressure may increase when you take NSAIDs. You also need to monitor liver and kidney function,” she said. “A big deal is the GI. If someone has suffered from heartburn, GERD, or stomach ulcers in the past, or has a history of stomach ulcers, or simply has a fairly sensitive gastrointestinal system, these medications must be used with caution. And if anyone has a history of bleeding, stomach ulcers, or stomach ulcers, we advise against using them.”

Other suggestions in response to the American College of Rheumatology:

  • Each NSAID has its own dosage. The dosage of over-the-counter medicines is usually lower than prescription versions of the identical medicine. NSAIDs often start working inside just a few hours. Pain control tends to occur way more quickly than the effect on swelling.
  • Do not mix NSAIDs or take greater than the really useful dose. Do not give aspirin to children under 12 years of age. Teens with a virus must also avoid medications that contain aspirin. There is a risk of Reye's syndrome, a rare but fatal disease that may affect the brain and liver.
  • If you might be pregnant, considering pregnancy, or breastfeeding, tell your doctor before you begin taking this medication. Some patients taking NSAIDs could have difficulty becoming pregnant. In these rare cases, it's endorsed to stop taking NSAIDs before conception.

Both Keaton and Bose consider that there are people in high-risk groups who simply shouldn't take NSAIDs.

“Patients with hypertension or elevated blood pressure need to be careful,” Bose said. “Similarly, patients with a history of liver and/or kidney disease need to be very careful. And depending on the stage or phase of their disease, they probably don’t need to take NSAIDs.”

“Anyone who has recently had a cardiovascular event or surgery – whether it's a heart attack, a stroke or someone who has had heart surgery – those are patients in whom we don't want to take an NSAID alone,” Keaton said . “In addition, any patient who has a history of bleeding, particularly bleeding in the stomach or gastrointestinal tract, will definitely want to avoid taking NSAIDs.”