Exploring NSAIDs: Pain relief, inflammation control and potential risks

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to relieve pain, reduce inflammation, and lower fever. Available in over-the-counter and prescription forms, they are crucial in managing various conditions, from headaches and muscle pain to arthritis and post-surgical recovery. While effective, NSAIDs also carry potential risks, making it important to understand their uses, benefits, and possible side effects.

How NSAIDs work

NSAIDs work by blocking cyclooxygenase (COX) enzymes, which produce prostaglandins—substances responsible for pain, inflammation, and fever. There are two types of COX enzymes: COX-1 and COX-2. COX-1 helps maintain the stomach’s protective lining and supports kidney function, while COX-2 is primarily involved in the body’s inflammation and pain response.

Types of NSAIDs

Non-selective NSAIDs block both COX-1 and COX-2, making them effective at reducing pain and inflammation. However, they also increase the risk of gastrointestinal issues because they inhibit COX-1, which protects the stomach lining. Common examples include ibuprofen, aspirin, naproxen, ketoprofen, and oxaprozin.

These medications are widely used for pain, inflammation, and fever management. However, long-term use or high doses may lead to stomach ulcers, digestive discomfort, and an increased risk of bleeding.

To address the gastrointestinal risks associated with non-selective NSAIDs, selective COX-2 inhibitors were developed. These drugs specifically target the COX-2 enzyme responsible for inflammation and pain while sparing COX-1. As a result, they lower the risk of stomach ulcers and other gastrointestinal complications.

Commonly prescribed COX-2 inhibitors include celecoxib (Celebrex) and meloxicam (Mobic), while others, such as rofecoxib (Vioxx) and valdecoxib (Bextra), were withdrawn from the U.S. market due to safety concerns. Although these medications reduce stomach-related risks, they are often more expensive and may increase the likelihood of cardiovascular problems, possibly due to their impact on blood clotting and heart function.

Common uses of NSAIDs

NSAIDs are commonly used to manage mild to moderate pain and inflammation. Over-the-counter NSAIDs are widely available for treating conditions such as headaches, muscle pain, fever, and minor swelling. Many people rely on them for temporary relief of common aches and pains.

For more severe or chronic pain, prescription NSAIDs are recommended. These are often used for long-term conditions like arthritis, post-surgical recovery, and persistent inflammatory diseases. Because they are stronger, they require medical supervision to minimize risks and potential complications.

Potential risks and side effects

Despite their effectiveness, NSAIDs are associated with several risks and side effects. Some of the minor side effects include headaches, dizziness, and nausea. However, more serious complications can occur with long-term use or in individuals with certain health conditions.

Stomach ulcers, kidney damage, and an increased risk of cardiovascular events are among the most concerning risks. People with a history of heart disease, gastrointestinal issues, or kidney problems need to be cautious when taking NSAIDs and should consult a doctor beforehand.

Aspirin therapy is sometimes used to prevent heart attacks and strokes, but it should only be done under medical supervision. Although aspirin helps prevent blood clots, it also increases the risk of bleeding, which can be dangerous for some individuals. Additionally, children and teenagers recovering from viral infections should not take aspirin due to the risk of developing Reye’s syndrome, a rare but serious condition that affects the liver and brain.

Alternative and emerging pain management solutions

In some cases, alternative methods for pain and inflammation relief may be beneficial, especially for individuals who cannot take NSAIDs due to health concerns. Physical therapy and rest are often recommended for managing chronic pain and injuries.

Some individuals find relief through dietary changes, such as incorporating anti-inflammatory foods such as fatty fish, nuts, and leafy greens into their meals. Another option is topical treatments, which are applied directly to the skin over painful areas. These alternatives can sometimes be as effective as NSAIDs, particularly for localized pain management.

As research advances, the search for safer and more effective pain management solutions continues to evolve. Recently, the FDA approved Journavx (suzetrigine), a promising non-opioid medication for treating moderate-to-severe acute pain. This approval represents a significant advancement in pain management, offering a potential alternative for individuals at risk of complications from NSAIDs or opioids.

Today’s approval is a historic milestone for the 80 million people in America who are prescribed a medicine for moderate-to-severe acute pain each year

Reshma Kewalramani, M.D.

Safe use of NSAIDs

While NSAIDs are highly effective for pain relief and inflammation control, they must be used responsibly to minimize potential risks. Taking the lowest effective dose for the shortest possible duration is the best approach to reduce side effects.

Individuals should also be mindful of possible drug interactions and underlying health conditions that may affect the safety of these medications. Consulting a healthcare provider before starting or adjusting NSAID use is always recommended.

As research into safer pain relief alternatives continues, the FDA remains committed to exploring new options, particularly in response to the ongoing opioid crisis. While NSAIDs remain an essential part of pain management, understanding their benefits, risks, and proper use allows individuals to make informed decisions regarding their health.