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If you have ever had a headache or pulled a muscle, you have probably headed to the medicine cabinet to reach for a pain killer. Over-the-counter pain medicines are affordable and safe for most people in the United States. They are so common that many people don't think twice about taking them to manage discomfort.
The most common pain medications are a class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs). Like all medications, NSAIDs have risks, including stomach problems, allergic reactions, and an increased risk of heart attack. Your risk of complications from pain killers might increase depending on your age, what other medications you're taking, and your health in general.
Learn more about whether anti-inflammatory pain relievers are safe for you.
What are anti-inflammatory medications?
Non-steroidal anti-inflammatory drugs or NSAIDs are some of the most commonly used medicines available. This class of medications includes:
- Aspirin (full dose)
- Celecoxib (used in Celebrex)
- Diclofenac (used in Votaren)
- Ibuprofen (used in Advil or Motrin)
- Naproxen (used in Aleve)
Ibuprofen and naproxen are all available over the counter. Higher doses of ibuprofen and naproxen are available with a prescription. Celecoxib and diclofenac are only available with a prescription.
Aspirin is only considered an NSAID when taken at full dosage. Your doctor may recommend low-dose aspirin to reduce your risk of a heart attack. In the lower dose, aspirin doesn't pose the same health risk as full-strength NSAIDs.
These medicines are effective at dulling pain, reducing inflammation, and reducing fevers. When used moderately, they are generally considered safe. However, like any medication, they have potential risks.
Dosing and duration
Experts say that taking NSAIDs for a short time at the lowest effective dose is generally safe. If you have an injury or a fever, it is probably safe to take an over-the-counter NSAID to relieve symptoms. However, you should not exceed the recommended dose, and you should be cautious about how long you take pain medicine. Ask your doctor about the maximum daily amount you should take and how many days in a row it's safe to do so.
If you have long-term or chronic pain, talk to your doctor about whether NSAIDs are the best choice for treating you. There may be other options that would work better.
Allergic reactions to NSAIDs
Some people have rare but serious reactions to NSAIDs. Symptoms of an allergic reaction to NSAIDs can include:
- Hives
- Itching
- Swelling of the lips, tongue, or face
- Coughing, wheezing, or chest tightness
- Nasal congestion, or runny nose
- Red or watery eyes
- Anaphylaxis
If you have an allergic reaction to an anti-inflammatory medicine, you should talk to your doctor about it. You should avoid NSAIDs if you have ever had an allergic reaction to them in the past.
NSAIDs and stomach issues
The most common complication from NSAIDs is digestive problems. These medicines can give you minor stomach upset or indigestion. In more severe cases, people can develop gastritis, ulcers, or bleeding in the stomach or intestines.
The risk of stomach problems from NSAIDs goes up if you have other conditions or take certain medications. You may be high risk if you:
- Are 65 or over
- Have ever had a stomach ulcer or gastritis
- Currently have a chronic inflammatory bowel disease
- Are already taking an NSAID regimen
- Are taking low-dose aspirin for heart issues
- Are taking blood thinners, prescription steroids, or SSRI antidepressants.
NSAIDs and heart disease and stroke risk
There is evidence that the use of non-aspirin NSAIDs can increase your risk of heart disease or stroke if you take them for a prolonged period of time. Higher doses are more likely to cause heart complications. The risk of heart-related complications from NSAIDs increases if you already have heart disease.
NSAIDs and kidney disease
If you already have reduced kidney function, you should avoid NSAIDs. The medications increase the risk that you will develop acute kidney failure. Talk to your doctor about whether you should take NSAIDs at all.
NSAIDs and pregnancy
The FDA recommends that you avoid NSAIDs after the 20th week of pregnancy. The medications can lead to rare but serious kidney problems in the developing fetus. They can also cause low amounts of amniotic fluid in the womb, which can lead to pregnancy complications.
Alternative treatments
If your doctor says you shouldn't take NSAIDs, ask what other medications you can use instead. For some people, acetaminophen (used in Tylenol) is a good alternative for pain management. Non-medication treatments such as heat or ice on injuries, physical therapy, or complementary medicine such as acupuncture may be appropriate.
If you have a condition that causes chronic pain, discuss your treatment options with your doctor. Prescription medications such as steroids, muscle relaxants, or opioids may be options to manage your condition.