NSAIDs

Nonsteroidal Anti-Inflammatory Medications

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Nonsteroidal anti-inflammatory pain medications, commonly referred to as NSAIDs (pronounced en-sayds), are some of the most commonly prescribed medications, especially for patients with orthopedic conditions such as arthritis, bursitis, and tendonitis. These medications are available over-the-counter (e.g. Ibuprofen, Motrin, Aleve) or as a prescription (e.g. Celebrex, DayPro, Relafen). NSAIDs are effective at both pain relief (analgesia), and to reduce swelling (anti-inflammatory).

How They Work

Medications that work to reduce inflammation come in two major categories:

  • Steroids (e.g. Cortisone)
  • Non-Steroidal Anti-Inflammatory Medications (NSAIDs)

Steroid drugs used in the treatment of inflammation are a derivative of a natural hormone produced by the body called cortisol. There are also other types of steroids (including cholesterol and sex hormones), but this third category is a powerful anti-inflammatory medication. Steroid medications can be given orally, systemically, or as a localized injections, as is commonly used in orthopedics.

NSAIDs work to block the effect of an enzyme called cyclooxygenase. This enzyme is critical in your body's production of prostaglandins. It is prostaglandins that cause swelling and pain in a condition such as arthritis or bursitis. Therefore by interfering with the function of cyclooxygenase, you decrease the production of prostaglandins, and decrease pain and swelling associated with these conditions.

Simple, right?

Well, there's more to it. Prostaglandins also have other important functions in the body. One type of prostaglandin (there are many varieties) helps line the stomach with a protective fluid (called gastric mucosa). When people take NSAID medications, the production of this protective fluid can be diminished, and some people are at risk for developing stomach ulcers.

Newer/Prescription NSAIDs Better?

In the past several years, some newer medications have come on the market; these are commonly referred to as COX-2 inhibitors. Remember, all NSAIDs work against cyclooxygenase (COX). Traditional NSAIDs (e.g. Ibuprofen, Motrin, Aleve) work against both COX-1 and COX-2. COX-1 and COX-2 are both types of cyclooxygenase enzymes that function in your body. The new medications (e.g. Celebrex) work primarily against COX-2, and allow COX-1 to function normally. Because COX-1 is more important in producing the protective lining in your gut (gastric mucosa), these newer NSAIDs are believed to have less of a risk of causing stomach ulcers.

That said, the newer NSAIDs have not been shown to work any better against the COX-2 enzyme. Therefore, the COX-2 inhibitors have the benefit of possibly having fewer side-effects, but not necessarily better relief from symptoms.

Side-Effects of NSAIDs

NSAIDs can be obtained over-the-counter, but that does not mean they are with out potentially serious side-effects.

The most common side-effect is irritation of the stomach. The cause of this is thought to be due to the effect on the stomach lining. If the irritation is severe, it may lead to bleeding ulcers, and potentially serious complications.

Before you start taking NSAID medications you should talk to your doctor. Be sure to let your doctor know about other medical problems you have, especially hypertension, asthma, kidney, or stomach problems. In addition, let your doctor know other medications you may be taking, and if you have any known allergies to medications.

NSAIDs should NOT be used if:

NSAIDs should be used only under CLOSE physician supervision if:

  • You have asthma
  • You have liver problems
  • You have heart problems
  • You have kidney problems

Bottom Line: Are NSAIDs Safe?

Nonsteroidal anti-inflammatory medications are very safe and can be very effective. Often effects can be achieved with use for a relatively short duration of time. That said, these medications do have possible side effects and cannot be used by every individual. While most people with a condition that causes inflammation can find NSAIDs to be helpful, you should always discuss with your doctor if you are thinking of starting one of these medications.

Sources:

Berger, RG "Nonsteroidal Anti-inflammatory Drugs: Making the Right Choices" J. Am. Acad. Ortho. Surg., Oct 1994; 2: 255 - 260.

van Tulder MW, et al. "Non-steroidal anti-inflammatory drugs for low-back pain The Cochrane Database of Systematic Reviews 2006 Issue 1.

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