Easing Chronic Pain With Anti-Inflammatory Drugs: NSAIDs

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Pain Management Health Center

Living With Chronic Pain

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Living With Chronic Pain
Myths About Chronic Pain Does chronic pain ever go away? Separate myths from facts.
9 Pain Pill Mistakes How to avoid the most common pain pill mistakes.
What Causes Chronic Pain? From arthritis to back problems, learn what causes chronic pain and what to do.
Sex and Chronic Pain More comfortable positions, coping with fatigue, and medication side effects.
Parenting with Chronic Pain How to cope with chronic pain and still be the best parent you can be.
Acute and Chronic: Types of Pain When does pain become something you should talk to your doctor about?
Talking About Pain How it feels, how it rates on a pain scale, and how the pain affects you.
Going to the ER How to reduce stress and suspicion when seeking chronic pain medications.
Anti-inflammatory Drugs Understanding how NSAIDs work to relieve pain.
Alternative Pain Treatments From acupuncture to supplements, commonly used alternative pain treatments.
10 Tips to Reduce Chronic Pain What you can do on your own, at home, to help relieve your pain.

Easing Chronic Pain With Anti-Inflammatory Drugs

(continued)

How Do I Know Which NSAID Will Work for My Chronic Pain? continued...

Your doctor should know all the medicines you take. Your doctor can advise you if the NSAID may interact with other medications you take. Also, your doctor can suggest the right dose for you. As you continue to take the medicine, your doctor can also monitor its effect, and raise or lower the dose as needed.

Before recommending a specific pain pill, your doctor will want to consider:

your medical history
past surgeries
your current health concerns
allergies and past reactions to drugs
other medicines you take
the functioning of your liver and kidneys
the drug's expense
your overall treatment plan and goals

When you talk with your doctor, be sure to ask about anything you don't understand.

Are There Side Effects and Special Cautions Associated With NSAIDs?

Specific side effects vary from drug to drug. For instance, some NSAIDs are harsher on the stomach than others. But there are certain side effects that are common to NSAIDs as a class. Serious side effects include:

bleeding problems
damage to the stomach and small intestine lining that can lead to ulcers
kidney disease
elevated blood pressure
muscle cramps
hearing problems

Other side effects include:

dizziness or headache
nausea
excess gas
diarrhea or constipation
extreme tiredness or weakness
dry mouth

Your doctor or your pharmacist can give you specific information about the side effects of the particular drug you are taking.

In addition to side effects, there are serious health risks associated with NSAIDs. It is important to talk with your doctor before taking NSAIDs if any of the following apply to you:

You are allergic to aspirin or any other pain reliever.
You have more than 3 alcoholic drinks a day.
You have stomach ulcers or bleeding in your digestive tract.
You have liver or kidney disease.
You have heart disease.
You take blood-thinning medicine or have a bleeding disorder.

Although aspirin taken in low doses with a doctor's supervision can help protect some people from heart attack, certain NSAIDs can increase your risk of heart disease and stroke. They can also interfere with blood pressure medicine, making it less effective.

Children and teenagers under the age of 18 should not take aspirin unless their doctor says to. There is a risk of Reye's syndrome, a potentially fatal disease.

So Should I Take an NSAID to Manage My Chronic Pain?

Anti-inflammatory drugs have a long history of success. Many people are able to manage their chronic pain quite well using NSAIDs as part of their management plan. For most, side effects, if any, are minor. But all medications have associated risks. All medications also have benefits. Deciding to take an NSAID or any medication involves weighing the risk against the benefit.

The bottom line: talk with your doctor. Your level of risk depends on the state of your overall health. Your doctor can help you determine whether or not an NSAID would be right for you.

1 2

WebMD Medical Reference

Reviewed by Laura J. Martin, MD on May 16, 2012

Living With Chronic Pain

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Important Safety Information About Cymbalta^®

The most important information you should know about Cymbalta:

Antidepressants can increase suicidal thoughts and behaviors in children, teens, and young adults. Suicide is a known risk of depression and some other psychiatric disorders. Call your doctor right away or seek emergency help if you have new or worsening depression symptoms; unusual changes in behavior, such as agitation, irritability, impulsivity, or restlessness; or thoughts of suicide. Be especially observant within the first few months of treatment or after a change in dose. Approved only for adults 18 and over.

Cymbalta may be associated with serious side effects. Call your healthcare provider right away or seek emergency help if you experience any of the following:

Itching, right upper-belly pain, dark urine, yellow skin/eyes, or unexplained flu-like symptoms, which may be signs of life-threatening liver problems. Severe liver problems, some fatal, have been reported
High fever, confusion, stiff muscles, muscle twitching, or racing heart rate, which may be signs of serotonin syndrome, a potentially life-threatening condition
Abnormal bleeding, especially if Cymbalta is taken with aspirin, NSAID pain relievers (like ibuprofen or naproxen), or blood thinners
Serious, possibly life-threatening skin reactions, which may include skin blisters, peeling rash, mouth sores, hives, or other allergic reactions
Abnormal mood (mania), which may include greatly increased energy, severe trouble sleeping, racing thoughts, talking more or faster than usual, and reckless behavior
Seizures or convulsions
Decreased blood pressure upon standing, which can cause dizziness or fainting, mostly when first starting or increasing the dose. Cymbalta can also increase blood pressure. Your healthcare provider should check your blood pressure prior to and while taking Cymbalta
Headache, weakness or feeling unsteady, confusion, problems concentrating, or memory problems, which may be signs of low sodium levels in the blood. Elderly people may be at greater risk
Problems with urination, including decreased flow or inability to pass any urine
Changes in appetite or weight. Children and adolescents should have height and weight monitored

Do not stop Cymbalta or change your dose without talking to your healthcare provider, as you could have side effects.

Cymbalta is not for everyone. Do not take Cymbalta if you:

Are taking or have recently taken a monoamine oxidase inhibitor (MAOI), including the antibiotic linezolid, or Mellaril^® (thioridazine). Taking Cymbalta close in time to these medicines can cause serious or even life-threatening side effects
Have uncontrolled narrow-angle glaucoma (eye pain due to increased eye pressure)

Before taking Cymbalta, talk with your healthcare provider:

About all your medical conditions, including
- kidney or liver problems, heart problems, or high blood pressure
- glaucoma or diabetes (Cymbalta may worsen diabetes or a type of glaucoma)
- seizures/convulsions, mania, or if you have bipolar disorder
- if you have ever had or been told you have bleeding problems, low sodium levels in your blood, or delayed stomach emptying
About all prescription and over-the-counter medicines and supplements you take or plan to take, including
- antibiotics or medicines for migraine, mood, or psychotic disorders, to avoid a potentially life-threatening condition when taken with Cymbalta
- aspirin, NSAID pain relievers, or blood thinners, because they may increase risk for bleeding
About your alcohol use (you should not take Cymbalta if you drink heavily)
If you are pregnant or plan to become pregnant during therapy or are breast-feeding

Most common side effects of Cymbalta (this is not a complete list):

Nausea, dry mouth, sleepiness, fatigue, constipation, decreased appetite, increased sweating, dizziness. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

Other safety information about Cymbalta:

Cymbalta may cause sleepiness and dizziness. Until you know how Cymbalta affects you, you shouldn't drive a car or operate hazardous machinery
People age 65 and older who took Cymbalta reported more falls, some resulting in serious injuries

How to take Cymbalta

Take Cymbalta exactly as directed by your healthcare provider. Do not open, break, or chew capsule; swallow it whole. Cymbalta is available by prescription only.

See Prescribing Information, including Boxed Warning about antidepressants and risk of suicide, and Medication Guide.

DD CON ISI 02OCT2012

DD80746 11/2012

Safety Information and Boxed Warning | Prescribing Information | Medication Guide

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