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Non-Steroidal Anti-Inflammatory Drugs

Millions of people suffer from acute and chronic pain associated with sports injuries, arthritis and other conditions. Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs frequently prescribed to treat pain caused by inflammation.

NSAIDs are generally safe and non-addictive, making them the ideal treatment for many conditions.

How NSAIDs Work

NSAIDs work by targeting an enzyme produced in the body called cyclooxygenase. Cyclooxygenase comes in two forms: COX-1 and COX-2. Both enzymes create prostaglandins, hormone-like substances that play a role in inflammation:

COX-1 creates prostaglandins that aid kidney function, protect the stomach lining and aid the production of platelets. Thus, blocking COX-1 can lead to stomach irritation and can increase bleeding times.
COX-2 produces prostaglandins that indicate pain in joints and muscles as well as promote fever as a defense against bacterial and viral infections.

Most NSAIDs prohibit the production of both COX-1 and COX-2 enzymes. However, certain NSAIDs have little effect on COX-1 and target COX-2 specifically. One of the most common COX-2-specific NSAIDs is Celebrex®. Often, you will hear this category of NSAIDs called COX-2 inhibitors. Since COX-2 inhibitors do not inhibit COX-1, they are much gentler on the stomach than typical NSAIDs.

NSAIDs: Common Names

There are a number of NSAIDs on the market. Each varies in its potency, how it is processed by the body and the duration of its effects. Common over-the-counter NSAIDs include:·aspirin·ibuprofen (i.e. Motrin® and Advil®)·naproxen (e.g., Aleve®).

Taking NSAIDs

NSAIDs are most commonly prescribed to individuals who are suffering from acute pain and fever. Over-the-counter NSAIDs, including aspirin and ibuprofen, are effective in treating:

arthritis
headaches
menstrual cramps
sports injuries.

Stronger prescription NSAIDs, such as ketorolac, are often used in place of opioids to treat severe pain. However, many prescription NSAIDs should not be used for longer than five days, as they can cause irritation to the stomach as well as stomach ulcers and stomach bleeding.

NSAIDs: COX-2 Inhibitors

Since COX-2 inhibitors only block COX-2 enzymes, they do not affect the stomach in the way traditional NSAIDs do and do not increase a person's risk of developing stomach ulcers. Thus, COX-2 inhibitors are particularly attractive to people who want to reduce inflammation without increasing the risk of developing stomach conditions, including people with arthritis.

However, COX-2 inhibitors have been linked with an increased risk of cardiovascular problems. Thus, a doctor will review a patient's medical history thoroughly before prescribing a COX-2 inhibitor. People with a history of heart conditions should not take this type of medication.

Some brand names for COX-2 inhibitors include:

Bextra®
Celebrex®
Vioxx®

In 2004, drug company Merck voluntarily recalled Vioxx®, due to its potential to cause heart attacks and stroke. Bextra® was removed from the market in 2005.

NSAIDs: The Risks

Like all other drugs, NSAIDs do carry some risks. The most common side effects of NSAIDs include:

decreased appetite
diarrhea
drowsiness
nausea.

Additionally, prolonged use of certain NSAIDs can lead to stomach problems. Stomach problems associated with prolonged use of certain NSAIDs include:

holes in the stomach and intestines
stomach bleeding
stomach ulcers.

NSAIDs are not recommended for people with certain conditions, including those who suffer from kidney disease and those who experience stomach ulcers.

Women who are pregnant should also consult with their doctor prior to taking NSAIDs, as there are some risks involved with specific products. Children with chickenpox should not take NSAIDs, as they can lead to Reye's syndrome, a condition that can cause brain swelling and liver damage.

In addition, NSAIDs can negatively impact the performance of certain prescription drugs. People who take diuretics may experience additional kidney problems when taking NSAIDs, due to the fact that COX-1 helps support healthy kidney functions.

Individuals on a regimen of prescribed anti-coagulants should also avoid most NSAIDs, as they can contribute to increased bleeding times.

In general, NSAIDS are an effective and safe treatment for acute pain, inflammation and fever. While there are some risks associated with these drugs, their side effects are limited to specific conditions that may be avoided given the great variety of NSAIDs available.

Resources

American Academy of Orthopedic Surgeons (n.d.). What are
NSAIDs?. Retrieved on August 28, 2007, from the American
Academy of Orthopedic Surgeons Web site:
http://orthoinfo.aaos.org/fact/thr_report.cfm?
Thread_ID=398&topcategory.

Ogbru, Omudhome, Pharm D. (n.d.). Nonsteroidal
Antiinflammatory Drugs (NSAIDs). Retrieved on August 28, 2007,
from the MedicineNet Web site:
http://www.medicinenet.com/nonsteroidal_antiinflammatory
_drugs/article.htm.

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