NSAIDs for Chronic Pain: Risks of Long-Term Use

If you have chronic pain, chances are you've turned to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief on more than one occasion. However, chronic or long-term use of NSAIDs—defined as more than three times a week for more than three months—can have negative health effects.

This article discusses the use of NSAIDs like ibuprofen and naproxen for chronic pain, how these drugs work, and how to take them. It also discusses the potential side effects and problems with the long-term use of NSAIDs.

What Are NSAIDs?

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are pain medications often used to treat muscle and joint pain, though they may be used for nerve pain in some cases. NSAIDs fall under the heading of non-opioid analgesics or non-narcotic pain medications. Typically, using NSAIDs for chronic pain is most effective when your pain is mild or moderate.

Unlike opioids, many NSAIDs can be purchased over the counter. Ibuprofen and naproxen, both NSAIDs, are readily available in drug and convenience stores. Prescription-strength NSAIDs for chronic pain are also available if your pain is more severe. In these cases, NSAIDs may also be combined with opioids to better control your pain.

How NSAIDs Relieve Pain

NSAIDs reduce pain in two ways. First, they alter the sensation of pain by blocking certain enzymes that participate in the pain response. Second, they work to reduce swelling that is often associated with certain types of pain. Some NSAIDs, however, are only effective at reducing swelling when taken at higher doses.

Most NSAIDs are taken by mouth, and their strength varies depending on the type of medication and dosage used. When you take NSAIDs for chronic pain, you may take a short-acting version combined with long-acting pain medication, such as an opioid or an adjuvant analgesic (an anticonvulsant or an antidepressant). This is especially true if you have breakthrough pain. However, a long-acting NSAID for chronic pain may be enough to control your symptoms.

Types of NSAIDs for Chronic Pain

Some of the more commonly available over-the-counter NSAIDs for chronic pain include aspirin, ibuprofen, and naproxen. These pain medications are sold in different non-prescription strengths and may be combined with other ingredients, such as caffeine or acetaminophen.

• Prescription-strength versions of NSAIDs are available as well. Some commonly used prescription NSAIDs for chronic pain include Mobic (meloxicam) and Celebrex (celecoxib), a COX-2 inhibitor.

COX-2 inhibitors are a newer type of NSAID that selectively targets the COX-2 enzyme to ease pain and inflammation. COX-2 inhibitors have fewer gastrointestinal side effects than traditional NSAIDs but carry great cardiovascular risks.

Is Long-Term Use Safe?

When NSAIDs are used regularly over an extended period of time, as is often the case with chronic pain, the potential for side effects increases. Evidence suggests that the potential for NSAID-associated complications increases as you get older. Some more common side effects include:

• Stomach irritation and ulcers
• Gastrointestinal (GI) bleeding
• Increased potential for bruising
• Exacerbation of asthma symptoms
• Increased risk of stroke, heart attack, and blood clots
• Kidney damage

If you plan to be on NSAIDs for chronic pain long-term, your healthcare provider may alter the dosage. He or she may also provide you with other prescription medication that offsets the potential for developing any of the above conditions. The potential for NSAID complications may be increased if you:

• Smoke
• Drink alcohol regularly
• Are a senior
• Have a history of heart disease
• Have high blood pressure
• Have ever had any GI problems
• Have kidney or liver disease

All NSAIDs, both prescription and over-the-counter, now sport warning labels thanks to a ruling by the Food and Drug Administration. Despite the warnings, using NSAIDs remains one of the most popular ways to relieve pain.