The Medical Minute: NSAIDS can be safe and useful, when used properly

Minor aches and pains from overexertion, age-related symptoms, or injury during exercise are something most of us deal with from time to time. Over-the-counter non-steroidal anti-inflammatory drugs, or NSAIDs, can be a good option. But as with any drug, they carry risks and should be taken properly to give greatest benefit with the least risk of side effects, according to Dr. Dov Bader, an orthopaedic surgeon with Penn State Sports Medicine in State College, part of Penn State Hershey Bone and Joint Institute.

What are NSAIDs?

Non-Steroidal Anti-Inflammatory Drugs are used to treat inflammatory conditions such as joint pain from arthritis, joint swelling from injury, sore muscles and tendons from overuse, and bursitis.  NSAIDS also have pain-reducing effects and can lower fevers.  However, NSAIDS are different than acetaminophen (Tylenol), particularly in their ability to decrease inflammation. NSAIDs include aspirin, ibuprofen (Motrin), and naproxen (Aleve).

How do NSAIDs work?

These medications block the action of an enzyme called cyclooxygenase, or COX.  There are two forms of the enzyme at work in your body.  COX-1 helps protect the stomach lining from digestive acids, as well as maintain kidney function.  COX-2 leads to the production of inflammatory chemicals such as those produced when joints are injured or inflamed from arthritis.  Traditional NSAIDs block the action of both COX-1 and COX-2 enzymes, which is why they can ease pain and inflammation, but can also cause stomach pain and bleeding or other complications.

When to use NSAIDs?

NSAIDS can be very useful in treating injuries and osteoarthritis.  At low doses, they can be effective pain relievers.  “However, higher doses than over-the-counter recommendations are necessary to achieve the full anti-inflammatory benefits and should only be taken over a one to two week period,” Bader says. “After that, you may take them as needed or if your symptoms return, you may repeat another short course.”  If your injury requires anti-inflammatory dosing, Bader recommends discussing a more detailed plan with your orthopaedist or family doctor. You should take NSAIDs with food or milk to minimize stomach side-effects.  You should not take more than the daily recommended dose, as this could lead to permanent kidney failure. Taking NSAIDs long-term (continuously for more than three months) should be discussed with your doctor so that blood tests can be used to monitor your liver and kidneys.  Also, since NSAIDs can cause bleeding, you should stop taking any NSAIDs seven days before any planned surgery.

Who can use NSAIDs?

Bader says most healthy individuals can safely take NSAIDs. If you have high blood pressure or kidney disease, discuss NSAID use with your primary care doctor prior to use, as they can increase blood pressure.  If you have a history of stomach ulcers or risk of bleeding, you should avoid NSAIDs.  People at risk for heart attack or stroke should discuss the risks of NSAIDs before long-term use.  As with any medication, if you have questions or concerns, you should consult your physician.

Taken at the proper dose for a safe duration, NSAIDs can be a powerful tool in the treatment of muscle, tendon, and joint pain.  Hopefully, these tips will help keep you active, healthy, and in the game.

The Medical Minute is a weekly health news feature brought to you by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff and are designed to offer timely, relevant health information of interest to a broad audience.

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March 14, 2013 Penn State Health News

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