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Are Anti-Inflammatory Pain Relievers Safe for You?

Here's help weighing the benefits and risks of NSAIDs, from aspirin to Celebrex

Understanding NSAIDs continued...

"Pain is not just an inconvenience," says rheumatologist John Klippel, MD, President and CEO of the Arthritis Foundation, Atlanta, GA. "It can be devastating. It can destroy people's lives. NSAIDs can be a valuable treatment."

Before you can decide what medicine is right for you, it helps to understand NSAIDs. NSAIDs are a common class of painkillers. They include all non-steroidal anti-inflammatory medicines, even aspirin, which helps protect the heart. The most common over-the-counter NSAIDs are:

  • Aspirin (Bayer, Ecotrin, and St. Joseph)
  • Ibuprofen (Advil, Motrin IB, Nuprin)
  • Ketoprofen (Actron, Ordus KT)
  • Naproxen sodium (Aleve)

Other NSAIDs available by prescription include Daypro, Indocin, Lodine, Naprosyn, Relafen, and Voltaren.

Cox-2 inhibitors are a newer form of prescription NSAID. Two of them -- Bextra and Vioxx -- are no longer sold because of concerns about their side effects. The third, Celebrex, is still available.

How Anti-Inflammatory Pain Relievers Work

While the details are different, all of these medicines work in more or less the same way. They block the effects of chemicals that increase the feeling of pain. Unlike many other painkillers, they also help by reducing swelling, which can further reduce pain. Sometimes swelling is a key cause of pain.

But the problem with NSAIDs -- or any systemic drug -- is that they can affect the entire body, not just the part that hurts.

"If you use a drug to ease one problem, like an achy joint," Goldberg tells WebMD, "it's likely to cause a different reaction somewhere else too."

Anti-Inflammatory Pain Relievers: The Risks

For most people, taking an over-the-counter NSAID for the occasional headache or backache is very safe. "The bigger risks are for people who have chronic pain and take NSAIDs in the long-term," says Goldberg.

The most common side effect from all NSAIDs is damage to the gastrointestinal tract, which includes your esophagus, stomach, and small intestine. More than half of all bleeding ulcers are caused by NSAIDs, says gastroenterologist Byron Cryer, MD, a spokesperson for the American Gastroenterological Association.

"Gastrointestinal bleeding is a serious issue," says Cryer. "But we've seen in many surveys that people really underestimate this risk." Most ulcers caused by NSAIDs will heal once you stop taking the drug, according to the American College of Gastroenterology.

Researchers developed Cox-2 inhibitors -- like Celebrex, Vioxx and Bextra -- to get around this problem, says Klippel. Contrary to common belief, Cox-2 inhibitors are not more powerful painkillers than standard NSAIDs. Their advantage is they are much less likely to cause gastrointestinal problems.

However, after their introduction in 1999, further study revealed that the Cox-2 inhibitors had a real downside: an increased the risk of heart attacks and strokes. The heart risks of two Cox-2 inhibitors, Bextra and Vioxx, were considered significant enough to pull them from the market. Bextra also posed a risk of serious skin reactions. Celebrex is still for sale, but it now bears a strong FDA warning about the risks of heart attacks and strokes.

These heart risks may also be common to many over-the-counter NSAIDs when used long-term, although probably to a lesser extent, Klippel tells WebMD. Except for aspirin, all over-the-counter NSAIDs now must carry a warning about the risks of heart attack and stroke along with other side effects.

NSAIDs have other dangers, too. They can cause high blood pressure and kidney damage in some people. They can also cause potentially severe allergic reactions. Both prescription and over-the-counter NSAIDs now carry warnings about skin reactions as well.

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