Non-steroidal anti-inflammatory drugs (NSAIDs) are very commonly prescribed medications in the treatment of pain and inflammation. They are often used to treat joint pain and muscular aches (musculoskeletal pain). This can arise for simply ‘over doing it’ or can be a specific problem like arthritis.
These medications may be used in combination with others, such as Paracetamol or Codeine that reduce pain in a variety of situations.
Some NSAIDs are advertised in the media as ‘over the counter’ tablets, or as creams that can be applied and rubbed into the affected area. They are also marketed as a treatment for headache.
Clearly, as the name would suggest, they are anti-inflammatory medications that do NOT contain steroids. Steroids are the most powerful anti-inflammatory medications and are not used as a first line treatment. NSAIDs are not without side-effects and complications and so should only be used when really necessary.
NSAIDS are often referred to as analgesics or ‘pain-killers’. They bring relief when they have reduced the inflammation. Often it is sensible to take them regularly for a period of time, to damp down the inflammation, rather than as a ‘one-off’. So it may take several days or a few weeks to feel the benefits.
If the NSAID does not provide benefit over the recommended timeframe of use it should be stopped. There is no point taking ANY medication that does not achieve its goal, the patient is simply exposing themselves to potential side-effects, with no net gain.
There appears to be a variation from patient to patient, as to which NSAID suits them best. It is not simply a case of which NSAID is ‘strongest’, there may be a genetic predisposition to which NSAID would be most effective in any one individual. Therefore if the first NSAID that you try is unhelpful, it is often worth trying an alternative, or indeed a COX II Inhibitor (see below).
How to use NSAIDs
- If you are using NSAIDs for a headache then most often 1 tablet is all that you need.
- If you have aches and pains from having over exercised, making the muscles and joints feels stiff, then you would gain more benefit from taking the tablets regularly. The number of times per day would be explained in the information leaflet that comes with the medication.
- More severe mechanical problems would require a more prolonged use of the medication, perhaps months.
- These medications are best taken with food, or at least a glass of milk.
- Often, another medication may be prescribed at the same time, to reduce stomach acidity and reduce the possibility of NSAIDs causing gastric irritation.
You should always read the information leaflet that comes with the medication. Often the list, as with ALL medications, can be quite daunting. The pharmaceutical company that makes the product is obliged to record any negative effect however uncommon. If these problems develop for you soon after taking the NSAID, then it is wise to discontinue its use and contact the person who prescribed it.
If you are taking any other regular medications, you should check with your doctor or pharmacist that the combination is safe. For example, NSAIDs are not recommended for a patient who takes a blood-thinning (anticoagulant) agent such as Warfarin.
If you have a history of upper intestinal trouble, such as acid reflux, or previous ulceration, then NSAIDs are often avoided.
Most patients do tolerate NSAIDs either alone or with an antacid.
- Upper abdominal bloating.
- Feelings of nausea.
- Acid reflux.
- Fluid retention. This can occur anywhere in the body, but most often affects the senior population, by causing swollen ankles.
These problems can be very mild and may not preclude further use, but if persistent or become more severe, then the medication should be stopped.
- Gastric ulceration. This is suspected with severe or persistent upper abdominal pain.
- Gastric bleeding. This may reveal itself as a dark stool, when the bowels open.
- Increased blood pressure (hypertension).
- Heart failure.
- Kidney damage.
- Allergic reactions.
These problems usually occur with prolonged use of anti-inflammatory medications. If you already have heart failure or kidney disease, then NSAIDs should be avoided as they can make the situation worse.
Cyclo-oxygenase II Inhibitors (COX II Inhibitors)
These medications are similar to NSAIDs. They are also anti-inflammatory medications. They have been designed to try and provide a good anti-inflammatory action, but to be less likely to cause problems with the upper intestine and stomach. Sadly, however, COX II Inhibitors have not solved all the problems and there are 4 possible responses:
- Effective pain relief and no gastric upset.
- Effective pain relief but still with gastric upset.
- Poor pain relief and no gastric upset.
- Poor pain relief but still with gastric upset.
The majority of patients do tolerate these medications, but as with NSAIDs they may be prescribed with an antacid.
The role of NSAIDs in treating pain
In the treatment of moderate to severe musculoskeletal pain, NSAIDs are NOT a solution on their own. The medications should be used to bring the pain under control so that you may achieve the following:
- Restore function and mobility.
- Control pain to enable restorative sleep, if this has been interrupted.
- Try and identify the posture or activity that provoked the pain and either change the way you do it, or avoid it altogether if possible.
- If a joint or other mechanical structure is damaged, then exercise to strengthen the supporting muscles around that structure would help reduce the severity and frequency of subsequent episodes.
When the painful episode has subsided then the NSAID should be stopped.
Other indications for NSAIDs
In some circumstances NSAIDs can be used prophylactically. For example, if you were to take on an activity that is challenging, or you fear may re-provoke the pain, then taking the medication in advance can be helpful…
If you were to take on a journey abroad that involved taking a flight, then there are challenges to face. At the airport, hefting luggage, standing around waiting and going through security does not make for a happy time. Once abroad, unfamiliar beds, chairs, sun-loungers and/or perhaps taking on new or energetic activities may ‘flare-up’ a problem that had settled.
By taking the NSAID through the day of travelling and the next day, may prevent the inflammation and pain from even starting. Some may choose to take the NSAID regularly through the whole holiday and then stop again, particularly if it is an ‘action holiday’ like skiing. This strategy does not suit, or work for everybody.
Overall, NSAIDs are well established and safe medications if used appropriately. Changing from one NSAID to another may result in the patient finding the best option for them. The medication should not be used as a long term strategy – identifying the provoking problem and dealing with it is very important, to reduce the time spent using the medication. If the NSAID is ineffectual it should be stopped.