What do they do?

NSAIDs are used to relieve pain and inflammation associated with arthritis and related conditions. They are also have many uses outside of arthritis treatment, such as lowering fevers, easing tooth aches, and relieving muscle aches from strenuous physical activity or the flu.

How do they work?

All NSAIDs work by blocking hormonelike substances called prostaglandins. Prostaglandins are involved in pain and inflammation as well as many other bodily functions, including protecting the stomach lining from its own digestive fluids.

Traditional NSAIDs block prostaglandins by inhibiting two enzymes, cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2).  By doing so, however, they leave the stomach vulnerable to ulcers and bleeding.

Celecoxib (Celebrex), which is referred to as a COX-2 inhibitor, on the other hand, blocks only the COX-2, enzyme, which is responsible for pain and inflammation, without affecting COX-2, which plays a role in stomach protection. For that reason it is less likely to cause damage to the stomach.

Who are they for?

NSAIDs are used to relieve pain and inflammation in virtually every form of arthritis and related condition – as well as many other conditions. For many people they provide sufficient relief at a reasonable price. But they are not for everyone. For example, if you have experienced an allergy to aspirin, you should not take a traditional NSAID, which is likely to produce the same response.

Your doctor may also consider analgesics or other options for pain relief if you have a history of stomach ulcers and/or bleeding, kidney or liver disease, heart disease, high blood pressure or asthma.

What’s important to know about the drug class?

Although NSAIDs are among the most commonly used medications for arthritis – and some are available without a prescription – they are serious medicines with potentially serious risks.

All NSAIDs may cause an increased risk of serious blood clots, heart attacks and stroke, which can be fatal. This risk may increase with higher doses and long-term use. If you already have cardiovascular disease or risk factors for it, you could be at greater risk. These drugs should not be used for pain in people having coronary bypass surgery.

NSAIDs can also cause gastrointestinal bleeding, which can occur without warning. For reason, regular checkups are important. If you take NSAIDs long-term, you should have blod counts and liver enzymes checked periodically.

Although all NSAIDs work similarly to ease pain and inflammation, for unknown reasons, some people experience more relief from one NSAID than another. Finding the best NSAID for you may take some trial and error. Unless your doctor has a reason to prescribe a particular NSAID – for example, a COX-2 inhibitor or one with additional stomach-protective ingredients if you are at high risk for ulcers – you might start with the least expensive option. Typically this would be generic ibuprofen or naproxen, which may cost less than $5 (even without insurance!) for a 30-day supply at some discount store pharmacies. If one of these doesn’t sufficiently relieve pain and inflammation, ask your doctor to prescribe another.

See all NSAID drugs.