Anti-inflammatories, non-steroidal 

Introduction 

Arthritis

Arthritis causes pain and inflammation of the joints and bones. It affects around 8 million people in the UK and is one of the three most common musculoskeletal diseases, along with osteoporosis and back pain. Dominic Arkwright reports on the condition.

Media last reviewed:

Next review due:

Aspirin

Aspirin was the first NSAID to be developed in 1897. Aspirin is still widely used in other countries, but in the UK its use as a painkiller has decreased. This is because there are other painkillers with the same level of effectiveness, but with a lower risk of side effects, such as ibuprofen and paracetamol (paracetamol is not considered an NSAID). Nevertheless, aspirin is widely available over-the-counter and its short term use in younger adults is considered relatively safe.

In the UK, aspirin is now primarily prescribed for its ability to prevent blood clotting  and thus reducing the likelihood of heart attacks and strokes. The medical term for this use is antiplatelet medication. 

Read more about the benefits of low-dose aspirin in thinning the blood.

Pain

What to do about different types of pain, including joint pain, back pain and migraines, and managing long-term pain

Non-steroidal anti-inflammatory drugs (NSAIDs) are a medication widely used to:

  • relieve pain
  • reduce inflammation (redness and swelling)
  • bring down a high temperature (fever)

NSAIDs are used to treat a wide range of conditions.

Common acute (short-term) conditions that can be treated with NSAIDs include:

Common chronic (long-term) conditions that can be treated with NSAIDs include:

Things to consider when using NSAIDs 

NSAIDs are associated with a small increase in the risk of a person experiencing a heart attack, stroke or heart failure.

NSAIDs are only used in people who have an existing high risk of developing these types of conditions if there are no suitable alternatives and the medications bring significant benefit.

High-risk groups include:

  • those with a history of previous heart attack, stroke or heart failure
  • people aged 75 or over
  • people with diabetes
  • smokers
  • people with high blood pressure

NSAIDs are also not usually recommended for people who:

  • are pregnant or breastfeeding
  • have a history of kidney disease
  • have a history of liver disease
  • have active stomach ulcers (a sore in the lining of the stomach), or are at risk of developing stomach ulcers

Read more about the things to consider when using NSAIDs.

For people who are unable to take NSAIDs for medical reasons, the painkiller paracetamol can be used as a safe alternative. For more severe pain, prescription painkillers, such as codeine or tramadol, can be tried.

Or in cases of severe inflammation an injection of steroids (corticosteroids) can often help.

Read more about alternatives to non-steroidal anti-inflammatory drugs

Side effects

Most people take NSAIDs without having any side effects. Short term use is unlikely to cause significant problems, especially in younger patients.

If side effects do occur they usually affect the stomach and intestines (gastrointestinal tract) and can include:

In older patients (aged over 55), or those who have had previous stomach ulcers, but who need long term NSAID treatment, stomach acid suppression medications are often prescribed in combination with NSAIDs to reduce the risk of stomach ulcer complications. 

Read more about the side effects of NSAIDs.

Interactions

It is very important to read the patient information leaflet that comes with your medication as some NSAIDs can either react unpredictably with other medications, or make them less effective.

For example, it is usually not recommended to take an NSAID if you are also taking medication to prevent blood clots such as low-dose aspirin or warfarin.

Read more about potential interactions that can occur with NSAIDs.

Dosage

NSAIDs are available in:

  • tablet or capsule form
  • as a topical treatment (a cream, gel or lotion rubbed into a specific part of the body)
  • eye drops – used to treat eye pain

Less commonly, NSAIDs are used as a suppository – a capsule inserted into the rectum (back passage).

It is important to strictly follow all of the instructions about the recommended dosage for your particular NSAID. If you exceed the recommended dose, you risk experiencing a wide range of adverse effects, some of which can be serious.

Read more about the recommendations on dosage for NSAIDs.

Names

In Europe, the most commonly prescribed NSAIDs are:

Most of the NSAIDs listed above are generic medicines. This means that their production and distribution is not limited to a single company. Therefore, they are available under a range of different brand names.

Some NSAIDs are available over-the-counter, without the need for a prescription, such as aspirin, diclofenac, naproxen and ibuprofen.

However, because a medication is available over the counter it does not mean it is safe or suitable for everyone. Again, it is important to read the patient information leaflet that comes with your medication.

It is generally accepted that naproxen is the safest NSAID with regard to heart attacks and strokes and celecoxib is the safest with regard to stomach problems.

Note: Aspirin must NOT be given to children unless directed by a doctor. Also, some people with asthma get attacks triggered by aspirin or NSAIDs.




Page last reviewed: 06/06/2012

Next review due: 06/06/2014

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Sheena 24 said on 06 October 2012

I didn’t know that I would ever be grateful that I’m allergic to aspirin and all those other NSAIDS, too, but now I am! I have to rely on paracatemol if I’m in pain, but I try not to take that unless I really need it. Don’t know what the US name for paracetamol is, but I understand that it’s not an NSAID.

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