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Chronic pain: Medication decisions

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are most effective for mild to moderate pain that's accompanied by swelling and inflammation. These drugs are commonly used for arthritis and pain resulting from muscle sprains, strains, back and neck injuries, or menstrual cramps.

  • Generic (brand) names. Ibuprofen (Advil, Motrin IB, others); naproxen sodium (Aleve); others
  • How they work. NSAIDs work by inhibiting certain enzymes in your body, called cyclooxygenase, that are released during tissue damage. By blocking the different types of cyclooxygenase (COX) — including COX-1 and COX-2 — NSAIDs can help reduce pain and inflammation that result from an injury.
  • Benefits and risks. When taken as directed, NSAIDs are generally safe. But if you take more than the recommended dosage — and sometimes even just the recommended dosage — NSAIDs may cause nausea, stomach pain, stomach bleeding or ulcers. Large doses of NSAIDs can also lead to kidney problems, fluid retention and high blood pressure. Risk of these conditions increases with age and in the presence of other health problems, including diabetes, a history of stomach ulcers or reflux, and kidney disease.
  • Bottom line. If you regularly take NSAIDs, talk to your doctor so that he or she can monitor you for possible side effects. Bear in mind that NSAIDs also have a ceiling effect — a limit as to how much pain they can control. This means that beyond a certain dosage, they don't provide additional benefit. Exceeding the recommended dose may not relieve your pain and may increase your risk of serious side effects.