NSAIDs or Non-Steroidal Anti-Inflammatory Drugs are a classification of drugs that include Ibuprofen (ie Advil), aspirin and naproxen (ie Aleve).  NSAIDs are some of the most common over the counter drugs used to treat inflammation associated with headaches, neck pain, back pain and sports injuries.

History of NSAIDs:

Use of NSAIDs has been recorded all the way back to the ancient Greeks who used willow bark to treat symptoms of fever. In 1897, a German chemist with Friedrich Bayer and Company was searching for a treatment for his father’s arthritis pain and produced the first stable form of aspirin.  Shorty after, aspirin was available  to physicians. Ibuprofen was invented in 1969 and was initially only available by prescription until 1984 when it became available over the counter.  Naproxen was originally available by prescription in 1976 and over the counter in 1994.

Risks of NSAID use:

The use of NSAIDs has typically been thought to be minimal with only minor side effects such as stomach pain and ulcers.  Recently new research on NSAIDs has caused concern and a call for more stringent regulation.  In this post we will discuss two risks associated with NSAID use, for a complete list of side-effects visit drugs.com.

The largest population-based matched case–control study of NSAIDs performed to date found that NSAID use increased the risk of first myocardial infarction (heart attack) by 40%.

Late in 2010 at the European Society of Cardiology Congress,  Dr Gunnar Gislason presented a study that looked at the relationship between the short term use of NSAID use and stroke. The study found a causal relationship with the use of NSAIDs with an increase of stroke by 30% with ibuprofen and naproxen.  They also found the risked to be dose dependent with the risk of stroke reaching 90% with the use of over 200mg of ibuprofen (a usual dosage for adults is 200-400mg every 4-6 hours).

Cochair of the session at which the study was presented, Dr Robert Califf (Duke Clinical Research Institute, Durham, NC), agreed that the results raised a major public-health issue, especially in the US, where many NSAIDs were available without a prescription.

Alternatives to NSAIDs:

  • Bromelain, a plant extract, has been shown to be effective in treating osteoarthritis and knee function along with muscle soreness.
  • Studies have show that the use of omega-3s (ie fish oils, flax oils) can treat inflammation and decrease the need for NSAID use in patients with neck and low back pain.
  • Boswellia, taken in pill form, and Turmeric, a spice, have been shown to be very effective for treatment of arthritis and muscle pain.
  • Willow bark was found to contain salicin that provided pain relief by Hippocrates.  Later salicin was isolated and became the active ingredient in Aspirin.