An Overview of Nonsteroidal Anti-Inflammatory Drugs

The Most Common Types of NSAIDs

Senior man looking at medication in a medicine cabinet
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Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of medications used to treat mild pain. They have similar properties to acetaminophen (Tylenol), relieving pain and lowering fevers. They differ from acetaminophen, however, because they also reduce inflammation. This is an important quality in the treatment of pain associated with inflammation. In palliative medicine, NSAIDs are commonly used to treat  pain related to bone cancers.

Which NSAID Is the Most Effective at Easing Pain?

There are several types of NSAIDs, but there is little evidence that one works significantly better than another.The most common ones used in palliative care are:

Aspirin. Aspirin is the original NSAID. Like acetaminophen, aspirin can be combined with opioid analgesics to optimize pain management. Aspirin is generally not used in palliative care patients, however, because of the risk of stomach upset and increased bleeding. Many patients with chronic illnesses who have an increased risk of heart attack or stroke are prescribed one 81mg "baby" aspirin per day.

Ibuprofen and Naproxen. Both ibuprofen and naproxen are available over-the-counter (OTC). Both can also be combined with prescription opioid medications. Ibuprofen is usually taken every four to six hours while naproxen is available in sustained-release form for twice a day dosing. Ibuprofen is available in a liquid form for patients who can't swallow pills, while naproxen is only available in pill form.

Ibuprofen is available as an OTC medication, usually in 200mg tablets. The usual dose is 200-400mg every four to six hours. It is also available as a prescription in 600- and 800mg tablets. It should not be used for more than 10 days at a time unless prescribed by a physician

Naproxen is available OTC with the usual dose being 250-500mg twice a day.

It is also available as a prescription controlled release tablet that is taken once a day.

The most common side effects from ibuprofen or naproxen are rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation, and heartburn. Both medications increase the risk of bleeding and stomach ulcers. If you are going to be on an NSAID for an extended period of time, your doctor may also prescribe medications to protect your stomach.

COX-2 Inhibitors. The newest class of nonsteroidal anti-inflammatory drugs is COX-2 inhibitors. They work much like traditional NSAIDs but carry a lower risk of stomach ulcers and bleeding. They are available only by prescription.

COX-2 inhibitors such as celecoxib (Celebrex) can carry an increased risk of heart attack or stroke. This risk increases the longer you are on the medication. This risk may or may not be one you are willing to take based upon your goals of care.

The Benefits Versus the Risks of Taking NSAIDs

Sometimes, in palliative care and hospice, long-term risks aren't as important to the patient or family because the immediate benefits are worth it to them. For example, someone who has a terminal illness with a life expectancy of two months or less and also suffers from severe arthritis may decide to risk any side effects of NSAIDs to have relief from pain.

These decisions are best made with your doctor.

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