Everything you need to know about NSAIDs

Non-steroidal anti-inflammatory drugs are pain relief or reducer medications. Aspirin and ibuprofen are the most common examples of that category of drugs.

The wider range of non-opioid analgesics also includes non-steroidal anti-inflammatory drugs (NSAIDs). This means they are a different form of opioid painkiller (such as morphine) that is usually reserved for more serious cases of pain.

NSAIDs are typically used for less serious forms of pain that arise from different aches and pain problems.

They contain some of the world’s most popular pain relief medications, used every day by approximately 30 million Americans.

Important facts about NSAIDs

The following are overview points about NSAIDs selected – more information are on offer in the article.

  • Many NSAIDs are available over the counter (OTC) – they are generally safe as long as they are used according to the label.
  • NSAIDs may be preferable for cramps, aches and pains, or pain problems involving fever or swelling.
  • There are risks in regularly taking NSAIDs over a long period, so patients should seek medical advice for long-term pain complaints.

What are NSAIDs?

NSAIDs include many common drugs such as ibuprofen.

Inflammation is a response to infection and damage from the immune system. The visible symptoms of inflammation are heat, redness, swelling, and pain.

When inflammation occurs, the body receives pain signals from nerve receptors. These signals are the result of complex responses and interactions within the body between cells and chemicals.

Anti-inflammatory medications partly minimize discomfort by reducing inflammation. People may use these drugs to relieve pain, stiffness, swelling and fever symptoms.

NSAIDs’ painkilling activity decreases the direct effect of inflammation on the stimulation and sensitivity of pain-nerve but also the indirect effect of inflammatory heat and swelling.

Examples of NSAIDs

OTC NSAIDs include:

Prescription NSAIDs include:

  • Oxaprozin
  • Etodolac
  • Indomethacin
  • Naproxen
  • Nabumetone
  • Diclofenac
  • Vimovo (Naproxen/Esomeprazole)

Function

NSAIDs are a large variety of medicines from many different groups. Although their chemical structures are different, they do have the following common effects:

  • they reduce high temperature and fever
  • they reduce inflammation
  • they reduce pain

NSAIDs work by slowing down compound formation, known as prostaglandins. Prostaglandins play a significant part in the inflammatory response of the body. Reducing the amount of prostaglandins released by the damage to the tissue reduces inflammation.

The NSAIDs block an enzyme, also known as COX, called cyclooxygenase. The COX enzyme assists the prostaglandin-producing reactions.

Blocking COX also interferes with platelets-blood cells that are involved in coagulation. Therefore NSAIDs have anti-coagulation effects.

This property helps prevent the blocked arteries that can cause heart attacks or stroke in the case of aspirin.

What are NSAIDs used to treat?

NSAIDs are used for three broad symptom types that occur in a range of conditions:

  • high temperature or fever
  • inflammation
  • pain

NSAIDs are used to ease pain in a number of conditions, including:

  • arthritis
  • backache – particularly long-term pain in the lower back
  • cold or flu
  • headaches
  • period pains
  • joint or bone injuries, sprains, and strains
  • muscle or joint complaints
  • toothache

Aspirin is used in small doses to help avoid cardiovascular disease which can cause heart attack or stroke. It can also be used to reduce the risk of other forms of colorectal cancer.

Headache and lower back pain are two of the most common reasons to use NSAID. If these issues are long-term problems, patients should consider the health of using NSAIDs.

Using NSAIDs for cold and flu

NSAIDs have been used to treat common cold symptoms for more than 100 years.

These medications, however, do not destroy the virus, or change the course of the disease. NSAIDs just ease some of the symptoms, including fever and pain.

A systematic review of the best evidence available to treat a common cold with NSAIDs reveals good effects against headache, ear pain and muscle and joint pain.

Precautions for using NSAIDs

How the body responds to NSAIDs varies from individual to individual and some people may experience side effects.

High doses and long-term use are more likely to cause some side effects.

Here are some general points concerning NSAID precautions:

  • Alcohol does not have an interaction with these particular painkillers, although drinking excessive amounts while using NSAIDs can irritate the gut and increase the risk of internal stomach bleeding.
  • People using other medications should let their pharmacist or doctor know.
  • Taking more than one kind of NSAID can also have adverse effects.
  • Patients should always follow the label for the particular NSAID they are using because every NSAID is different.
  • Individuals should not take NSAIDs at the same time as anti-clotting drugs, such as aspirin or warfarin.
  • Children under 16 years of age and people over 65 may need to avoid taking NSAIDS.

Many people who may need medical advice to stop or take such drugs:

  • people who are allergic to NSAIDs
  • asthma – this can be worsened by NSAIDs in some cases
  • women who are pregnant or breast-feeding
  • anyone with heart disease

Side effects of NSAIDs and long-term safety

A man having stomach pain
Side effects can include stomach pain and irritation.

Apart from the above precautions, taking NSAIDs may have side effects.

Serious side effects are less common than mild ones, and there is a varying possibility of any side effect between individuals. Those who take medications are more likely to have side effects at high doses or for a long term.

Compared with OTC NSAIDs, prescription NSAIDs usually have a higher risk and greater painkilling capacity.

Many people report less serious side effects including:

  • indigestion and other gut complaints
  • headaches
  • dizziness
  • drowsiness

Adverse events rarely associated with NSAIDs include problems with:

  • fluid retention
  • kidneys (see below)
  • liver
  • heart and circulation

Blood pressure – Blood pressure will increase with NSAIDs. They raising the blood supply to the kidneys, which means they function less harshly. It, in effect, triggers a build-up of fluid within the body. Blood pressure increases as there’s more fluid in the bloodstream. That can cause kidney damage in the long run.

The risk of heart attack and stroke is also significantly increased when taking NSAIDs, but not while taking aspirin at small doses

Peptic ulcers and gastrointestinal bleeding

Long-term or high-dose use of NSAIDs may also contribute to the production of ulcers in the stomach, called peptic ulcers. NSAIDs decrease prostaglandin activity, which decreases inflammation; however, prostaglandins also protect the lining of the stomach by helping it produce mucus. So NSAIDs leave the stomach open to acid effects.

People who are taking NSAIDs at long or high doses should consult their doctor about the prevention of ulcers. One alternative is to take separate medications which reduce the production of acid in the stomach. Another alternative is to employ a particular form of painkiller.

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