Are Anti-Inflammatory Pain Relievers Safe for You?

At age 62, April Dawson lives every day with chronic pain from wrist arthritis.

"There are a lot of everyday things I just can't do now," she says. "I can't open packages or jars or even lift a half-gallon of milk. Some days I can barely turn the ignition in my car."

But despite the pain and inconvenience, she takes no medication to relieve her suffering.

Her doctor tried her on some prescription anti-inflammatory drugs, "But I was always wary of using medicines," she says. "And when the news came out showing the risk of heart attacks and strokes, I decided to stay away from drugs altogether."

Dawson is in a common bind, one shared by many Americans. She suffers from severe chronic pain but fears the side effects of common painkillers called non-steroidal anti-inflammatory drugs (NSAIDs.)

Two anti-inflammatory drugs - Bextra and Vioxx - have been taken off the market because of heart risks and other side effects. A similar but slightly different drug, Celebrex, is available by prescription, with warnings about potential risk.

But even long-term use of over-the-counter anti-inflammatory medicines like ibuprofen and naproxen (Advil, Aleve, and Motrin) may carry some of the same risks.

What should you do if you, like April Dawson, suffer significant pain from arthritis? First, it's important to understand the tradeoffs you make with all medicine. Medications can cause side effects; they also can relieve suffering. It's important to talk with your doctor about the potential benefits versus risk in your particular case. Second, it's critical to be monitored by your doctor if you are taking any medicine regularly for longer than a couple of weeks. Careful monitoring can catch side effects early.

"There's no simple answer," says cardiologist Nieca Goldberg, MD, a spokesperson for the American Heart Association and Chief of Women's Cardiac Care at Lennox Hill Hospital, New York City. The degree of risk from NSAIDs varies greatly from person to person, she says, and depends on things like your medical condition and the medicines you take.

"Pain is a serious problem and it needs to be treated," says Goldberg. "But you have to do it in the safest way possible."

There is no question that the risks of NSAIDs can be serious, even life-threatening.

According to the American Gastroenterological Association (AGA), each year the side effects of NSAIDs hospitalize over 100,000 people and kill 16,500 in the U.S., mostly due to bleeding stomach ulcers.

But it's important to put those numbers in context. The AGA also says that every day, more than 30 million Americans use NSAIDs for pain from headaches, arthritis, and other conditions. And while some experts emphasize the dangers, others stress that living with chronic pain is terrible in itself.

"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.

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."