NSAIDs for Chronic Pain

If you have chronic pain, chances are you've turned to NSAIDs for pain relief at least once in a while. But is long-term use of NSAIDs safe? And what are the potential side effects? Here's what you should know about NSAIDs for chronic pain.

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.

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 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.

Some of the more commonly available over-the-counter NSAIDs for chronic pain include aspirin, ibuprofen, naproxen, and ketoprofen. 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 meloxicam and celecoxib. Nearly all NSAIDs, both prescription and over the counter, are taken orally.

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

If you plan to be on NSAIDs for chronic pain long-term, your doctor 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.