Safer Alternatives to NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat acute and chronic pain associated with conditions like arthritis. It is also used to reduce fevers and inflammations. They can also prevent blood from clotting. The most common over-the-counter NSAIDs include ibuprofen, aspirin, and naproxen.

These medications are not without side effects, however. Non-aspirin NSAIDs have been associated with an increased risk for heart attack, stroke, heart failure, and death from cardiovascular disease. Other common side effects include stomach pain, gas, bloating, and nausea. NSAIDs may also interfere with kidney function.

NSAID Side Effects

You may experience side effects if you take a large amount of NSAIDs or use the medications long-term. Some side effects are mild and will disappear on its own, while others require medical attention to resolve.

The most commonly reported side effects of NSAID use include: 

• Gas
• Bloating
• Heartburn
• Stomach pain
• Nausea
• Vomiting
• Diarrhea and/or Constipation
• Dizziness
• Lightheadedness
• Balance problems
• Not able to concentrate
• Mild headaches

To relieve gastrointestinal discomfort and symptoms, healthcare providers recommend taking NSAIDs with food, milk, or antacids. Unless your healthcare provider tells you to do so, don't take an over-the-counter NSAID with a prescription NSAID, multiple over-the-counter NSAIDs, or more than the recommended dose of an NSAID. Doing so could increase your risk of side effects.

This risk of side effects may be greater in people who:

• Are older
• Have previous history of stomach ulcers or bleeding problems
• Are on blood thinners
• Are on multiple prescription or over-the-counter NSAIDs
• Drink three or more alcoholic beverages a day

If you experience any severe stomach pain, black stools, bloody urine, blurred vision, chest pain, back pain, hearing problems, and allergic reactions, call your healthcare provider immediately.

NSAIDs and Heart Risks

Several studies, since 2000, have shown that long-term, high-dose use of all non-aspirin NSAIDs place you at increased risk for heart attack, stroke, heart failure, and death from cardiovascular disease. NSAIDs have also been found to increase blood pressure. These risks vary by individual drugs and seem to be affected by the baseline cardiovascular risk of people who take NSAIDs.

Although the reasons for the connection between NSAIDs and heart risks are not fully understood, there is sufficient proof for caution, specifically if your chance of heart disease is increased due to age, excessive weight, smoking, high-cholesterol, blood pressure, or a prior heart attack or stroke. The U.S. Food and Drug Administration requires that these risks be clearly outlined in the label of these medications.

Heart problems caused by non-aspirin NSAIDs can happen within the first weeks of use and may happen more frequently with higher doses or with long-term use. Non-aspirin NSAIDs should not be used right before or after heart bypass surgery.

For those at above-average risk for heart problems or have multiple risk factors and take NSAIDs such as diclofenac, celecoxib or ibuprofen, seven to eight cardiovascular episodes would take place per 1000 people who take these drugs. However, research indicates that naproxen shows the smallest risk compared with other NSAIDS.

Safer NSAID Alternatives

Due to the side effects of NSAIDs, many people are investigating alternatives that can help relieve pain and inflammation, including topical NSAIDs, acetaminophen, nonacetylated salicylates, as well as herbal remedies and dietary supplements, yoga, and acupuncture.

Acetaminophen

Acetaminophen is used to relieve the same types of mild to moderate aches and pains as NSAIDs in addition to reducing fever. Acetaminophen may also be used to relieve the pain of osteoarthritis. It works by changing the way the body senses pain and by cooling the body. Compared with NSAIDs, acetaminophen is easier on the stomach, but it may cause liver damage. It may cause side effects ranging from difficulty breathing to rashes or blistering skin. If you experience any of these side effects, call your healthcare provider as soon as possible. 

Topical NSAIDs

Topical NSAIDs have comparable effects on acute muscular and joint pain with a lower risk of side effects, specifically gastrointestinal ones. Topical NSAIDs are not absorbed into the blood to the same extent as oral NSAIDs, and people who use the topical form have lower peak blood levels of the medications and fewer adverse effects when using topical formulations compared with pills. Topical NSAIDs are said to be better for localized pain near the surface of the skin, such as pain in the hands and knees. One study found that topical NSAIDs offer relief for a minority of people with osteoarthritis.

For patients with a history of gastrointestinal bleeding or chronic kidney disease, topical NSAIDs have shown they provide relief and that adverse side effects were rare. People who use topical NSAIDs should closely following the dosing instructions from their healthcare providers, however, especially those who had previous adverse reactions to NSAIDs.

Nonacetylated Salicylates

If you’re concerned with the gastrointestinal damage and bleeding and want to avoid aspirin, you may want to try nonacetylated salicylates. They are more potent than acetaminophen but much less than aspirin. These drugs reduce pain and inflammation, but will do less damage to your stomach or prompt excessive bleeding. 

Arnica

Arnica is an herb found primarily in Siberia and in parts of Central Europe and North America. The flowers are used for medicinal purposes to alleviate pain from osteoarthritis, sore throat, surgery, and other ailments. Arnica is commonly used for bruising, bleeding, and swelling. However, there is no scientific evidence that supports its efficacy for these conditions. 

Curcumin

Curcumin is derived from turmeric, a relative of the ginger family. It has been used in both Ayurvedic and Chinese medicines to reduce inflammation, as well as to treat digestive disorders and for wound healing. Standard dosage for turmeric powder is 400–600 mg taken three times per day. Side effects are few, but can cause an upset stomach, and, on rare occasions, gastric ulcers may occur if you’re taking a high dose. If you are taking anticoagulant medications or high doses of NSAIDs, caution is needed.  

Bromelain

Bromelain is a supplement for reducing pain and swelling in the nose, sinuses, gums, and other parts of the body after surgery or an injury. It is used for osteoarthritis, cancer, digestive problems, and muscle soreness. Its topical form is used for burns. 

Research indicates that there is conflicting information regarding whether Bromelain alone or combined with other substances relieves osteoarthritis pain or post-exercise muscle soreness. 

Topical Capsaicin

Capsaicin is a chemical found in chili peppers, and works by affecting nerve cells in the skin that are associated with pain. Topical capsaicin is used to reduce pain in muscles and joints caused by arthritis, muscle strains, bruises, cramps, and sprains.  

Capsaicin comes in various topical forms for the skin such as as an ointment, cream, gel, oil, and in several strengths. Inform your healthcare provider or pharmacist of other prescriptions you may be taking, as well as any vitamins, supplements, and herbal products.

Acupuncture

Acupuncture is a technique used in traditional Chinese medicine. By inserting fine needles into certain areas on your body, acupuncture can stimulate specific points to help relieve pain or other conditions. Research indicates that acupuncture may help alleviate chronic pain in the lower back, neck, knees and for individuals with osteoarthritis. Acupuncture can have a number of serious side effects if not properly executed. These include punctured organs, infections from non-sterilized needles, collapsed lungs, and damage to the central nervous system.

Yoga for Pain

Research indicates that yoga may help with relieving pain for certain conditions. For fibromyalgia, certain symptoms may be alleviated with yoga and other forms of exercise like muscle strength training, massage, and acupuncture. A 2020 review of 25 randomized controlled trials looked into its effect on back pain. Twenty studies indicated positive results in pain, depression, and anxiety. However, there was no discernible difference in pain after six weeks of yoga versus physical therapy.  

A Word From Verywell

No one wants to be in pain, whether it's from a mild headache or after a surgical procedure. NSAIDs have helped millions of people cope with their pain, but they do come with side effects that can develop into serious health problems. Be aware of the side effects, and let your healthcare provider know what other medications you’re taking so they can prescribe the appropriate dosage. And remember to notify your healthcare provider right away about any side effects you are experiencing so they can either modify the dose or prescribe a different medication to alleviate your pain.