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Principles of Health: Pain Management

Prescription NSAIDs

by Jodi L. Guy, , BSN, RN, CMSRN

CATEGORY: NSAID, Anti-Inflammatory

ANATOMY OR SYSTEM AFFECTED: Kidneys; Gastrointestinal system; Blood platelets

Key Terms

  • NSAID: non-steroidal anti-inflammatory drugs

  • cyclooxygenase: enzymes that catalyze the initial reactions that culminate in the synthesis of prostaglandins

  • platelets: blood cells that help your body form clots to stop bleeding

Many people worldwide deal with pain caused by chronic inflammatory conditions like arthritis or musculoskeletal problems and receive significant benefits from NSAIDs to manage their pain. NSAIDs are a type of anti-inflammatory analgesic medication used to treat mild to moderate pain, which can be short or long term in nature. They can also be used to assist in bringing down a fever. NSAIDs are not opioids and do not have addictive properties. They are relatively inexpensive and accessible, but it is crucial to understand how to use them properly. There are over 20 different brands of NSAIDs that can be purchased over-the-counter such as aspirin, Advil, or Motrin (ibuprofen), and Aleve (naproxen sodium). Many other NSAIDs are prescription medications prescribed by health care providers. Examples of prescription NSAIDs include Mobic (meloxicam) and Celebrex (celecoxib). Health care providers prescribe NSAIDs to patients who deal with chronic pain to help them manage their pain more effectively. For unknown reasons, patients differ in response to different NSAIDs, so if one isn’t working, another in the same class may work much better.

How NSAIDs Work

Oral NSAIDs work within one hour of taking the medication, and their effects usually last from 4-12 hours depending on whether they are short- or long-acting. Patients typically experience the maximum anti-inflammatory effects of NSAIDs after they have taken them for about two weeks.

NSAIDs inhibit cyclooxygenase enzymes (or COX enzymes) from working inside the body. These enzymes catalyze the formation of small molecules called “prostaglandins,” which activate pain receptor nerve endings, thus causing a sensation of pain, and mediate tissue inflammation. Prostaglandins also protect the gastrointestinal mucosa, regulate blood flow to the kidneys, and help with platelet aggregation. NSAIDs inhibit COX enzyme activity, which relieves pain. There are two subtypes of COX enzymes, COX-1 and COX-2. Most NSAIDs block the action of both COX-1 and COX-2, but usually specific NSAIDs inhibit one type of COX enzyme more than the other. Celebrex is the FDA-approved medication that specifically inhibits COX-2. The reduction of COX-1 enzymatic activity concomitantly reduces pain and inflammation. Unfortunately, blocking COX-1 also diminishes the gastric protective properties of prostaglandins and, therefore, causes damage to the mucosa of the gastrointestinal tract and increases the risk of gastrointestinal bleeding. Pharmaceutical companies developed new NSAIDs that specifically target COX-2 in hopes of assisting with inflammation and pain without the undesired gastrointestinal and bleeding effects. However, blocking COX-2 causes a greater risk of forming blood clots and having a heart attack or stroke.

Uses and Applications

NSAIDs are used for many types of pain, including; toothaches, strains and sprains, joint pain, muscle pain, earaches, headaches, and menstrual cramps, to name a few. Providers can prescribe NSAIDs in the form of pills, gels, or creams. Gels and creams are applied directly on the skin over the area of pain and provide similar benefits as the pill forms for arthritis and back pain. For some, the topical form may be safer than pill forms. The doses of prescription NSAIDs are higher than their over-the-counter versions.

Side Effects

In general, NSAIDs are relatively safe medications and benefit many individuals. Common side effects of NSAIDs may include dizziness, heartburn, constipation, epigastric pain, nausea, rash, tinnitus, edema, fluid retention, headache, or vomiting.

Those who are already at higher risk for gastrointestinal, cardiovascular or renal adverse effects will have an increased risk for adverse effects. Side effect profiles of specific NSAIDs depends on their selectivity for COX-1 or COX-2. Those NSAIDs that are relatively nonselective for COX-1 or COX-2, such as aspirin, have more gastrointestinal side effects such as nausea, heartburn, indigestion, and potentially peptic ulcers. However, at low doses, aspirin is cardioprotective. NSAIDs that are slightly more selective for COX-2 than COX-1, such as ibuprofen and naproxen, have a low risk of cardiovascular events, but a higher risk of gastrointestinal side effects, though not as high as aspirin. Those NSAIDs that are even more selective for COX-2, such as meloxicam, diclofenac, etodolac, indomethacin, piroxicam, nabumetone, and sulindac, should be used with caution in patients with increased risk for cardiovascular side effects, but have a lower risk for gastrointestinal side effects. Celecoxib, marketed as Celebrex, is entirely selective for COX-2 and carries the lowest low risk of gastrointestinal side effects, but the highest risk of blood clots, heart attacks, or stroke (in rare cases).

Patients on NSAIDs should take the lowest dose that achieves the desired effects. Such a strategy reduces the risk of adverse effects. Long-term NSAID use has serious side effects when taking high doses. Patients can prevent the gastrointestinal adverse effects of NSAIDs by taking medications such as proton pump inhibitors (PPIs) with the NSAID. Those with high blood pressure need to use caution when taking NSAIDs, as they can further increase their blood pressure. Patients with cardiovascular disease should exercise care when taking NSAIDs since they may increase the risk of cardiac events. Likewise, patients with chronic renal failure should also avoid NSAIDs since they can harm the kidneys. Pregnant women should not use NSAIDs during the last three months of pregnancy. As with any drug, there is also a risk of an allergic reaction.

References

1 

Goroczyca, Pamela, et al. “NSAIDs: Balancing the Risks and Benefits.” US Pharmacist, vol. 41, no. 3, 2016, pp. 24-26.

2 

Hecht, Marjorie. “Side Effects from NSAIDs.” Healthline, 23 July 2019, https://www.healthline.com/health/side-effects-from-nsaids#7-side-effects

3 

Perry, Laura, et al. “Cardiovascular Risks Associated with NSADs and COX-2 Inhibitors.” US Pharmacist, vol. 39, no. 3, 2014, pp. 35-38.

4 

Underwood, M., et al. “Advice to Use Topical or Oral Ibuprofen for Chronic Knee Pain in Older People: Randomized Control Trial and Patient Preference Study.” British Medical Journal, vol. 336, no. 138, 2007, pp. 1-12. doi:10.1136/bmj.39399.656331.25

5 

Shah, Seema, and Vivek Mehta. “Controversies and Advances in Non-Steroidal Anti-Inflammatory drug (NSAID) Analgesia in Chronic Pain Management.” Postgraduate Medical Journal, vol. 88, no. 1036, 2012, pp. 73-78.

Citation Types

Type
Format
MLA 9th
Guy, Jodi L. "Prescription NSAIDs." Principles of Health: Pain Management, edited by Michael A. Buratovich, Salem Press, 2020. Salem Online, online.salempress.com/articleDetails.do?articleName=POHPain_0036.
APA 7th
Guy, J. L. (2020). Prescription NSAIDs. In M. A. Buratovich (Ed.), Principles of Health: Pain Management. Salem Press.
CMOS 17th
Guy, Jodi L. "Prescription NSAIDs." Edited by Michael A. Buratovich. Principles of Health: Pain Management. Hackensack: Salem Press, 2020. Accessed September 19, 2025. online.salempress.com.