Non-steroidal anti-inflammatory drugs (NSAIDs) are big business in the United States. They are a mainstay of television advertising and a ubiquitous presence in drugstores and supermarkets.
Led by over-the-counter medications like ibuprofen, naproxen and aspirin, more than 30 billion doses of NSAIDs are consumed every year in the United States alone.
Americans take NSAIDs to treat headaches, backaches and arthritis, often with an incomplete knowledge of the dangers associated with them.
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What’s what Some common NSAIDs, available without a prescription: Ibuprofen (Advil, Motrin) Naproxen (Aleve) Aspirin (Bayer, Bufferin) Some common prescription NSAIDs: Celecoxib (Celebrex) Ibuprofen (Motrin) Ketoprofen Naproxen (Anaprox) Piroxicam (Feldene) Sulindac (Clinoril) |
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“The whole class of drugs has risks,” said Robert Ghattas, pharmacist at Duran Pharmacy in Albuquerque. “They can cause stomach bleeding, ulcers, liver problems and asthma attacks. Long-term NSAID use can lead to kidney problems and even kidney failure. These are serious side effects.”
The widespread intake of NSAIDs results in more than 100,000 hospitalizations annually for gastrointestinal complications, according to a study in Arthritis Research & Therapy. Less serious side effects from NSAIDs include constipation, heartburn, nausea and dizziness.
NSAIDs are, as the name indicates, non-steroidal medications that treat inflammation. They work by inhibiting the body’s production of prostaglandins, hormone-like compounds that have a variety of important functions. While NSAIDs are generally safe for most people in the short term, long-term inhibition of prostaglandins through NSAID use can have serious consequences.
“People develop a tolerance and start to increase the dose, and that’s when they really start getting side effects,” said Ghattas.
Several studies have linked NSAIDs with an increased risk of cardiovascular events like heart attacks. In 2005, the U.S. Food and Drug Administration had to ask manufacturers of over-the-counter NSAIDs to revise their product labeling to more specifically address the risk of cardiovascular events and gastrointestinal bleeding.
A recent study in the Canadian Medical Association Journal found an increased risk of miscarriage in women who took non-aspirin NSAIDs.
People looking for an alternative to NSAIDs have several options that offer different safety profiles. Acetaminophen, which does not have the anti-inflammatory properties of NSAIDs, is a popular choice for fever and pain.
“Acetaminophen is very safe when taken within the guidelines,” said Dr. Steven Seifert, medical director of the New Mexico Poison Control Center. “The problems happen when taken in excess of recommended dose.”
Herbal remedies like ginger and bromelain – an enzyme extracted from pineapple – have shown promise in reducing inflammation, but research on the benefits is inconclusive.
“Ideally, you want something that’s been proven efficacious in clinical trials,” Seifert advised.
Beyond inflammation, neither NSAIDs nor herbal remedies address any underlying issues associated with chronic pain. For that, a diagnostic workup and treatments ranging from physical therapy to surgery is needed.
“There are lots of alternative approaches that physicians can use to figure out what’s causing the pain and then fix it,” Seifert said.
Complementary approaches to pain treatment like acupuncture and chiropractic medicine have gained traction in recent years. Dr. Lindsey Blessing, an Albuquerque chiropractor, often sees patients with pain.
“I use adjustments to manipulate the spine and the joints and relieve pressure on the nervous system,” she said. “When I was an intern at the Veteran’s Administration Hospital, lots of veterans there had chronic pain issues and had undergone failed lower back and neck surgeries. They would come to the chiropractor, and it was the only way they would feel better.”
Acupuncture is an option that relies on stimulation of specific points on the body – often by inserting thin needles through the skin. According to 2007 clinical practice guidelines issued by the American Pain Society and the American College of Physicians, acupuncture is one of several complementary and alternative medicine therapies physicians should consider when patients with chronic low-back pain do not respond to conventional treatment.
Despite the risks, NSAIDs remain an effective treatment for short-term pain, particularly when related to inflammation.
“Any drug that has an effect has side effects,” noted Seifert. “For most limited conditions, over-the-counter medications used as directed are a safe and reasonable approach.”
Just be sure to consult a medical professional before using.
“People have access to a great resource called pharmacists,” said Ghattas. “All they have to do is ask.”
