Making the Decision on NSAIDs

Should you take anti-inflammatory pain relievers regularly? Here are pros and cons to help you make your decision.

From the WebMD Archives

Experts agree that, for most people, there's no harm in taking nonsteroidal anti-inflammatory pain relievers, called NSAIDs, for the occasional headache, fever, or muscle ache. Indeed, on any given day more than 30 million Americans use NSAIDs to soothe headaches, sprains, arthritis symptoms, and other daily discomforts, according to the American Gastroenterological Association.

But these useful pain relievers also raise the risk of ulcers and heart problems in some people. Should you take an NSAID every day if you have arthritis or chronic pain?

To help you understand the pros and cons, WebMD turned to four experts for advice:

  • Byron Cryer, MD, a gastroenterologist, spokesman for the American Gastroenterological Association, and an associate professor of medicine at the University of Texas Southwestern Medical Center in Dallas.
  • Nieca Goldberg, MD, a cardiologist, spokeswoman for the American Heart Association, and chief of Women's Cardiac Care at Lennox Hill Hospital in New York.
  • John Klippel, MD, a rheumatologist and president & CEO of the Arthritis Foundation in Atlanta.
  • Scott Zashin, MD, a rheumatologist and clinical assistant professor at the University of Texas Southwestern Medical Center in Dallas.

Here is the information they gave to help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation. If you already know this basic information, you can jump directly to your NSAID decision worksheet and begin assessing the pros and cons as they apply to you.

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Key Points in Making the NSAID Decision

Consider the following when making your decision:

  • NSAIDs (nonsteroidal anti-inflammatory drugs) are a common class of over-the-counter and prescription painkiller. Examples include aspirin, Advil, Aleve, Motrin, and prescription drugs like Celebrex.

  • You should never take any over-the-counter medicine regularly without discussing it with your doctor. Most over-the-counter painkillers should not be used for more than 10 days.

  • Like any medicine, over-the-counter and prescription NSAIDs have side effects. The FDA has recently required that all over-the-counter and prescription NSAIDs -- except aspirin -- include warnings about possible risks of gastrointestinal and cardiovascular side effects and allergic reactions.

  • The risks of NSAIDs have been highlighted in the media recently. But it's important to understand that, for many people, NSAIDs are a safe and effective treatment. The key is to work with your doctor. Together, you can weigh the benefits and risks and decide on the best treatment in your case.

  • NSAIDs are not alike. They can have very different pros and cons. Talk to your doctor about the NSAID that might work best for you.

  • NSAIDs can appear in unlikely places. For instance, many over-the-counter medicines for colds and the flu contain doses of these pain relievers. Make sure you know the ingredients of any medicine you use.

  • There are alternatives to NSAIDs. Many people who can't take NSAIDs benefit from Tylenol (acetaminophen.) Other options for people with severe chronic pain are prescription narcotics, like OxyContin, Percocet, and Vicodin. Some find that physical therapy, weight loss (if overweight), biofeedback, yoga, meditation, and acupuncture can also reduce their pain.

  • In some people, complete pain relief isn't possible. But in such cases, you can focus on reducing your pain so that it doesn't interfere with your life.

What Are NSAIDs?

NSAIDs -- nonsteroidal anti-inflammatory drugs -- are a common treatment for ailments, such as joint pain, related to inflammation. They relieve pain, reduce swelling, and lower fevers.

Examples of over-the-counter NSAIDs are:

There are also prescription strength NSAIDS. Some examples are Daypro, Indocin, Lodine, Naprosyn, Relafen, and Voltaren.

Cox-2 inhibitors are a newer form of prescription NSAID. Celebrex is the only one of these drugs still on the market. Two others -- Bextra and Vioxx -- are no longer sold because of concerns about their side effects.

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How Do NSAIDs Work?

When you injure yourself, the damaged tissue releases certain chemicals. These chemicals cause the tissue to swell, and they amplify the feeling of pain. NSAIDs work by blocking the effects of these chemicals. As a result, you get less swelling and less pain.

What Are the Side Effects of NSAIDs?

The side effects -- and benefits -- of different NSAIDs vary. Here's a rundown of some of the more important risks.

  • Heart attacks and strokes. Experts believe that all NSAIDs -- except aspirin -- have the potential to increase the risk of heart attacks and strokes. Celebrex may be the most likely to cause these effects. However, aspirin can lower the risks of heart attacks and strokes because it reduces the risk of blood clots.

  • High blood pressure . All NSAIDs have the potential to raise high blood pressure. However, because aspirin has such good effects on the cardiovascular system, you doctor may ask that you take it especially if you are at risk for heart attack or stroke.

  • Heartburn, ulcers, and gastrointestinal (GI) bleeding. Most NSAIDs increase the risk of GI problems. Celebrex is the NSAID least likely to cause problems because it was designed to avoid GI side effects.

  • Kidney damage. NSAIDS can be damaging to the kidneys in some people.

  • Allergic reactions. NSAIDs can cause allergic reactions, resulting in wheezing, hives, facial swelling, and shock. Dangerous side effects may be more common in people with asthma, especially if they also have sinus problems or nasal polyps -- tissue growths on the inside of the nasal cavity.

Other Warnings

  • Many NSAIDs are not safe for pregnant women, especially in the last three months.

  • Children and teenagers should not take aspirin because it's associated with the serious disease Reye's syndrome.

  • Most over-the-counter and prescription pain relievers do not mix with alcohol. If you take an NSAID, including aspirin, just one drink a week can increase your risk of gastrointestinal bleeding. People who have three or more drinks a night should not use NSAIDs.

Your Decision on NSAIDs

Your choices are:

  • To take NSAIDs on a regular basis
  • Not to take NSAIDs on a regular basis

When deciding whether to use NSAIDs on a regular basis, you have to weigh both your personal feelings and the medical facts.

Reasons to Take NSAIDs Regularly Reasons Not to Take NSAIDs Regularly
  • NSAIDs help control your chronic pain.
  • NSAIDs have never given you any side effects.
  • You have never had an allergic reaction to an NSAID.
  • You have no kidney or liver problems.
  • You are not pregnant.
  • You are 60 or younger.

Are there other reasons you might want to use NSAIDs regularly?

  • NSAIDs don't really seem to help with your pain.
  • You have had significant side effects from NSAIDs in the past.
  • You have had an allergic reaction to an NSAID in the past, such as hives, swelling, or wheezing.
  • You have kidney or liver disease.
  • You are pregnant.
  • You are over 60, which puts you at higher risk of developing an ulcer.

Are there other reasons you might not want to use NSAIDs regularly?

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Making Your Decision on NSAIDs

Use this worksheet to help you make your decision. After finishing it, you should have a better idea of how you feel about using NSAIDs on a regular basis. Discuss the worksheet with your doctor.

For each question, circle the answer that best applies to you.

I am in chronic pain that restricts my life and activities. Yes No Unsure
NSAIDs help me control my pain. Yes No Unsure
I only get relief if I take NSAIDs in high doses. Yes No Unsure
I have high blood pressure. Yes No Unsure
I have had a heart attack, stroke, or heart surgery. Yes No Unsure
I have angina. Yes No Unsure
My doctor has told me that I am at a higher risk of heart attack or stroke. Yes No Unsure
I have kidney or liver disease. Yes No Unsure
I have a history of ulcers or gastrointestinal bleeding. Yes No Unsure
I am over 60 and am at higher risk of developing an ulcer. Yes No Unsure
I have asthma. Yes No Unsure
I have asthma as well as nasal polyps or sinus problems. Yes No Unsure
I have had an allergic reaction to an NSAID in the past. Yes No Unsure
I have to take steroids, like prednisone, for a medical condition. Yes No Unsure
I take anticoagulants or "blood thinners." Yes No Unsure
I have more than one alcoholic drink a night. Yes No Unsure

What Is Your Overall Impression About NSAIDs?

Your answers in the above worksheet may give you a general idea of where you stand on this issue. You may find that you have one overriding reason to use or not to use NSAIDs on a regular basis.

Check the box below that represents your overall impression about your decision.

Leaning toward using NSAIDs regularly
Leaning toward not using NSAIDs regularly










If you are leaning toward using an NSAID, which type and why?



WebMD Feature Reviewed by Cynthia Dennison Haines, MD on October 17, 2005

Sources

SOURCES: Byron Cryer, MD, spokesman, American Gastroenterological Association; associate professor of medicine, University of Texas Southwestern Medical Center, Dallas. Nieca Goldberg, MD, spokeswoman, American Heart Association; chief of Women's Cardiac Care at Lennox Hill Hospital, New York; author, Women Are Not Small Men: Lifesaving Strategies for Preventing and Healing Heart Disease in Women. John Klippel, MD, president and CEO, Arthritis Foundation, Atlanta. Scott Zashin, MD, clinical assistant professor, University of Texas Southwestern Medical Center; author, Arthritis Without Pain. American College of Rheumatology web site. Arthritis Foundation web site. American Heart Association web site. American Academy of Allergy, Asthma, and Immunology web site. American College of Gastroenterology web site. American Gastroenterological Association web site. American Academy of Family Physicians web site. American Academy of Allergy, Asthma, and Immunology web site.

© 2005 WebMD, Inc. All rights reserved.

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