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Pain relief: Taking NSAIDs safely

SEP 2013

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Before you use these popular pain pills, weigh the heart risks and other side effects carefully.

When your joints ache or your head throbs, you might turn to aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve) for pain relief. Millions of Americans rely on these and other nonsteroidal anti-inflammatory drugs (NSAIDs) every day.

NSAIDs are so widely used because they perform double duty. "They not only relieve pain, but they reduce inflammation too," says Dr. Lucy Chen, an assistant professor at Harvard Medical School and attending physician in the department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital.

NSAIDs work by blocking the production of chemicals in the body that contribute to pain and inflammation. Like all medications, NSAIDs have side effects and may not be right for everyone.

NSAID cautions

Because many women take NSAIDs daily for months or years to relieve chronic pain (such as arthritis and low back pain), it is especially important to watch out for side effects. Some risks of NSAIDs include the following:

  • Heart—NSAIDs have been linked to a greater risk for heart attacks, strokes, and heart-related deaths. Although all NSAIDs have been associated with increased heart risks, studies suggest that the prescription NSAID diclo-fenac (Voltaren and Cataflam) is most likely to cause heart problems, while naproxen appears to pose the least risk. The longer you take NSAIDs, the more your potential for heart problems goes up.

  • Stomach—People who take NSAIDs regularly are more likely to develop upset stomach symptoms, and potentially ulcers and bleeding in the gastrointestinal (GI) tract. You're more likely to have GI issues if you're older and you take more than one pain reliever (such as an NSAID plus low-dose aspirin).

  • Kidneys—NSAIDs can reduce blood flow to the kidneys, which could compromise these blood-filtering organs over time.

You should not take NSAIDs if you are taking warfarin (Coumadin) or clopidogrel (Plavix), and be careful if you're taking dabigatran etexilate (Pradaxa). People with certain medical conditions and older adults may be more likely to have side effects or complications if they take NSAIDs. Talk to your doctor about whether you can take NSAIDs if you have

  • Crohn's disease or ulcerative colitis

  • gastroesophageal reflux disease (GERD)

  • heart disease or a past history of heart attack or stroke

  • kidney disease

  • liver damage

  • ulcers, gastritis (inflammation of the stomach lining), or stomach bleeding.

Tips for taking NSAIDs safely

For most women, the occasional ibuprofen or naproxen tablet shouldn't cause problems. Before you take these drugs for longer periods of time, however, talk to your doctor. "You definitely want to first consult with a physician about whether to take NSAIDs, for how long you should take them, and at what dose," Dr. Chen advises.

Use NSAIDs at the lowest possible dose and for the shortest duration needed to relieve your pain. "Usually we don't recommend that patients take an NSAID long-term. If you have an acute arthritis flare-up, we usually recommend taking it for a week or two," says Dr. Chen. "If you need to take these drugs for a longer period of time, make sure your doctor is monitoring you for side effects and testing your kidney function," she says. You also may need to be checked for ulcers or stomach bleeding.

In addition to staying vigilant for side effects, there are things you can do to lower your risks while taking NSAIDs long-term. For example, you can take a proton-pump inhibitor (PPI) drug such as omeprazole (Prilosec) to reduce your chances of developing an ulcer. You can reduce your heart risks by eating a healthy diet, exercising regularly, and treating conditions that can contribute to heart disease, such as high blood pressure and diabetes.

Alternatives to NSAIDs

NSAIDs are a good pain relieving option, but they're not your only option.

For arthritis aches and pains, consider a topical NSAID that you rub on your skin, such as diclofenac sodium (Voltaren gel). It can relieve pain as well as oral NSAIDs, but with fewer gastrointestinal side effects.

You can also try one of these therapies:

  • acupuncture

  • biofeedback

  • exercise in warm water (pool or aquatic therapy)

  • heat—from a heating pad, hot shower, or bath

  • ice

  • physical therapy

  • stretching/yoga

  • weight loss to relieve stress on the joints.