Every year in the U.S., it is reported that about 29 million Americans use over the counter nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain, and their overuse is responsible for approximately 100,000 hospitalizations and 17,000 deaths.

NSAIDs include aspirin, but traditional non-aspirin NSAIDs are ibuprofen (Motrin or Advil), naproxen (Aleve), diclofenac (Voltaren), and selective cyclooxygenase 2 (COX2) inhibitors like celecoxib (Celebrex) and acetaminophen (Tylenol).

In a safety announcement by the FDA, they warned that using NSAIDs increases the risk of heart attack or stroke. While each non-aspirin NSAID has pain relieving benefits and risks, it may be complicated for patients and their health care providers to choose.    

“Patients and healthcare professionals should remain alert for heart-related side effects the entire time that NSAIDs are being taken,” the statement said.

What’s the difference in NSAIDs?

To bring some guidance in choosing the right NSAID as a pain reliever, researchers from FAU published a review in the Journal of Cardiovascular Pharmacology and Therapeutics; in which, they address risks that include cardiovascular, gastrointestinal, liver and kidney side-affects.

It was determined that all NSAIDs, including aspirin have benefits and risks, but here’s the breakdown.

Aspirin decreases inflammation as well as coronary events and stroke, but it increases gastrointestinal symptoms and bleeding. It does not have adverse effect on the liver or kidneys.

Non-aspirin NSAIDs such as ibuprofen, naproxen and diclofenac – decrease inflammation, but are associated with major coronary events and stroke with long-term use; as well as major upper gastrointestinal and kidney side-effects. Research also found that they’re responsible for electrolyte imbalances such as high sodium or potassium and even heart failure.

COX2 inhibitors – celecoxib and acetaminophen were developed primarily because of more favorable gastrointestinal side-effects relative to aspirin and traditional non-aspirin NSAIDs. However, they come with adverse cardiovascular, liver and kidney problems. Acetaminophen has no clinically relevant anti-inflammatory properties; it accounts for more than 50 percent of drug overdose related liver failure, and about 20 percent of liver transplant cases, as well as kidney disease.

How do you choose which NSAID is right for you?

To answer this, you should consult a healthcare provider to get to the root of the issue of what is causing your pain. Is it pain from hormonal changes or enzymes? Or does the pain stem from injury? These drugs were created to target specific regions for pain relief. Used for the wrong purposes can lead to overuse, and that can lead to serious medical issues.

“With respect to the benefits and risks of pain relievers, the totality of evidence suggests that health care providers and their patients should make individual clinical judgements based on the entire risk factor profile of the patient,” said Manas Rane, M.D., first author and a third-year internal medicine resident at FAU’s Schmidt College of Medicine. “Wise individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do more good than harm.”

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