When you suffer from headache pain or body aches, but you aren’t desperately ill, what is one of the first sources of relief you look for, whether in a pharmacy or in your home? Do you reach for aspirin, Tylenol, Advil, or some variation of one of these over the counter pain relievers? If you take a name brand or a store brand, they each have the same formula as required by law for their respective drug type. Typically, the generic version is going to be cheaper, and most of the time work just as well for most people.
According to the American Academy of Orthopaedic Surgeons, or AAOS, nonsteroidal anti-inflammatory drugs, or NSAIDs (pronounced en-saids), are the most prescribed medications for treating conditions such as arthritis. Most people are familiar with over-the-counter, nonprescription NSAIDs, such as aspirin and ibuprofen.
NSAIDs are more than just pain relievers. They also help reduce inflammation and lower fevers. They prevent blood from clotting, which is good in some cases but not so beneficial in others. For example, because they reduce clotting action, some NSAIDS, especially aspirin, may have a protective effect against heart disease. However, you may bruise more easily. NSAIDs can increase the risk of developing nausea, an upset stomach, or an ulcer. They also may interfere with kidney function.
There are some additional risks from taking NSAIDs, according to the AAOS. Tell your physician if you are pregnant, have high blood pressure, asthma, or a history of kidney or liver disease, or have had ulcers in the past. People older than 65 years of age must be especially careful when taking NSAIDs. Also tell your doctor about other medications you are taking. NSAIDs may intensify or counteract the effects of some medications. Both the risk and the severity of side effects increases the longer you take NSAIDs. More details can be found at this site: http://orthoinfo.aaos.org/topic.cfm?topic=a00284 .
According to www.RxList.com , NSAIDs are used for treating conditions that cause inflammation, mild to moderate pain, and fever. Examples include:
• headaches,
• coughs and colds,
• mild sports injuries,
• arthritis, and
• menstrual cramps.
Ketorolac (Toradol) is only used for short-term treatment of severe pain that usually requires opioid treatment. Aspirin is the only NSAID that is used for preventing strokes and heart attacks in individuals at high risk for such events. The most common side effects are:
• vomiting,
• nausea,
• constipation,
• diarrhea,
• reduced appetite,
• headache,
• dizziness,
• rash, and
• drowsiness.
NSAIDs also may cause swelling of the arms and legs due to retention of fluid. The most serious side effects are ulcers, bleeding, kidney failure , and, rarely, liver failure. Individuals allergic to NSAIDs may experience shortness of breath after taking an NSAID and may experience a similar reaction when other NSAIDs are taken. People with asthma are at higher risk for experiencing serious allergic reactions to NSAIDs.
Administering aspirin to children or teens with chickenpox or influenza has been associated with Reye’s Syndrome, a serious and potentially fatal disease of the liver. Therefore, aspirin and salicylates [for example, salsalate (Disalcid) should not be used in children and teenagers with suspected or confirmed chickenpox or influenza.
NSAIDs (except aspirin) may increase the risk of heart attacks, stroke, and related conditions, which can be fatal. This risk may increase with duration of use and in patients who have underlying risk factors for disease of the heart and blood vessels. NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft (CABG) surgery.
NSAIDs cause an increased risk of serious, even fatal, stomach and intestinal adverse reactions such as bleeding, ulcers, and perforation of the stomach or intestines. These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these types of reaction. Much more information can be found at this website: http://www.rxlist.com/script/main/art.asp?articlekey=94691 .
According to Consumer Reports, these drugs block the production of substances in the body called prostaglandins, which play a role in pain, inflammation, fever, and muscle cramps and aches. At low doses, NSAIDs work essentially as pain relievers. At higher doses, though, they can actually reduce the body’s inflammatory response to tissue damage as well as relieve pain.
Most oral forms of NSAIDs are now available as less expensive generic drugs. And three are available, in lower-dose formulations, as nonprescription over–the–counter drugs: acetylated salicylates (Aspirin, Bayer, Bufferin, and generic), ibuprofen (Advil, Motrin, and generic), and naproxen (Aleve and generic). Their costs vary from about $ 4 to more than $ 300 a month. Since individual needs vary, talk with your doctor about the medicine and dose that is right for you, and the possible risks. More details can be found at this site: http://www.consumerreports.org/health/best-buy-drugs/nsaids.htm .
A large percentage of people take NSAIDs and experience no side effects. NSAIDs are very effective for a wide range of conditions, according to Medical News Today. Patients and health care professionals must always remember, however, that the majority of drugs carry a risk of some side effects. Although not common for most people, NSAID side effects may be serious. In some cases, a combination of an NSAID with certain medications or alcohol may cause undesirable side effects. NSAID interactions with certain medications – if you or someone you know is taking an NSAID together with other medications, you should be monitored closely in case any side effects that are not desirable happen to develop. More details can be found at this site: http://www.medicalnewstoday.com/articles/179211.php .
Never use an over-the-counter NSAID continuously for more than three days for fever and 10 days for pain without consulting your health care provider, according to The Cleveland Clinic. Over-the-counter NSAIDs are effective pain-relievers, but they are intended for short-term use. Depending on the NSAID and the condition intended to treat some NSAIDs may work within a few hours while others may take a week or two before most benefits are achieved. Generally, for acute muscle injuries, it is recommended you should take NSAIDs that work quickly, but may need to be taken as often as every 4 to 6 hours because of their short action time. For osteoarthritis and rheumatoid arthritis which require long-term treatment it is generally recommended NSAIDs be taken only once or twice a day. However, it generally takes longer for these drugs to have a therapeutic effect. Before you start taking any new medication, ask your health care provider:
• What is the name of the medication?
• Why do I need to take it?
• How often should I take it?
• What time of day should I take it?
• Should I take it on an empty stomach or with meals?
• Where should I store the medication?
• What should I do if I forget to take a dose?
• How long should I expect to take the medication?
• How will I know it is working?
• What side effects should I expect?
• Will the medication interfere with driving, working, or other activities?
• Does the medication interact with any foods, alcohol, or other medications (including over-the-counter medications, herbal and/or dietary supplements)?
NSAIDs work like corticosteroids (also called steroids) without many of the side effects associated with steroids. Steroids are man-made drugs that closely resemble cortisone, a naturally-occurring hormone. This information is a summary only. It does not contain all information about this medicine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider. For much more detail on NSAIDs, you can visit this site: http://my.clevelandclinic.org/drugs/non-steroidal_anti-inflammatory_drugs/hic_non-steroidal_anti-inflammatory_medicines_nsaids.aspx .
Be careful with your pain relief. Make sure that you follow directions for any medication, including over the counter drugs. Always consult with your physician, especially if you are on any maintenance medications. Watch for signs that may be problematic, and monitor any changes in behavior or physical activities in children and teenagers when NSAIDs are given to them. As always, call 911 if you experience an emergency. NSAIDs can be very helpful, but they are still drugs. Treat them with respect and caution.
Until next time.
The Medical Center of Central Georgia, JOINT CARE, Macon GA.      
