NSAIDs: The Basics

Non-Steroidal Anti-Inflammatory Drugs, or NSAIDs, are medications that are commonly used to reduce pain and inflammation.

You are likely familiar with common NSAIDs like Advil, Aspirin and Naproxen, and have used them when fighting an illness or recovering from an injury.

NSAIDs work by blocking inflammation in the body to help you recover, feel better, and get back to the activities you love.

The risk of experiencing side effects from using NSAIDs is very low and therefore they are often recommended as a first line treatment for illness, injuries to bone, muscle and connective tissue (musculoskeletal), arthritis, and lower back pain.

Types of NSAIDs

NSAIDs come in two forms.

Either they are consumed as pills (orally) or rubbed onto the skin as a cream (topically).

Common oral NSAIDs include:

Common topical NSAIDs include:

• Pennsaid (diclofenac)
• Voltaren (diclofenac)

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Some important things to know about NSAIDs is that they…

• Can be taken as pills or applied as a cream
• Block inflammation signals in the body and reduce pain
• Allow for faster healing and recovery
• Have a very low risk of side effects
• Treat pain like Tylenol, but Tylenol does not reduce inflammation
• Help manage:
  • Illness
  • Lower back pain
  • MSK injuries
  • Arthritis
• Offer a much better alternative for treating pain compared to opioids (due to side effects and risk of addiction)

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How NSAIDs work

When you are injured or ill, inflammation is your body’s first response.

Signals are sent within the body that result in inflammation, leading to the classic symptoms of redness, swelling and pain.

These symptoms can be experienced at the location of an injury e.g., a painful sprained ankle, or across the body e.g., experiencing a fever when you have the flu.

NSAIDS work in the body by blocking these inflammation signals to reduce pain and symptoms of inflammation. While inflammation is important to healing, it can be excessive and cause prolonged symptoms.

Side Effects of NSAIDs

There is a very low risk you will experience side effects from taking NSAIDs. While these medications are specifically designed to relieve pain and prevent inflammation, it is possible for NSAIDs to affect the normal functions of your body. They can alter some of the normal and healthy processes in the gastrointestinal tract, heart and kidneys.

Though the risk of these side effects is very low, the risk does increase after 1-2 weeks of use. Therefore, use of NSAIDs should be kept to a short term. Furthermore, if you suffer from any pre-existing gastrointestinal, heart or kidney conditions, you should consult with a physician before taking NSAIDs.

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What about Tylenol?

Tylenol (acetaminophen) is not considered an NSAID.

Though it is a common pain relief medication and often used interchangeably with Advil, it works differently than NSAIDs in the body. After consumption, acetaminophen travels to the brain where it prevents pain signals.

It is also different from NSAIDs because it does not decrease inflammation. Therefore, Tylenol is a great pain relieving (analgesic) drug but doesn’t offer the anti-inflammatory benefit of NSAIDs.

What are NSAIDs typically used for?

Illness

If you are suffering from viral infections like a cold, the flu, or COVID-19, NSAIDs can be part of your management strategy. By reducing the body’s inflammatory response, they decrease fever and pain while your body fights the infection, making the symptoms of sickness more manageable. Recent evidence has even suggested that NSAIDs can prevent some of the processes that the COVID-19 and influenza A viruses use to cause infection, thereby reducing the length of illness further.

Bacterial infections are much different than viral infections and are treated using antibiotics. The effects of NSAIDs on bacteria are not well understood and we do not know of any benefit in combating bacterial illness. NSAIDs can, however, still offer pain relief if needed.

Lower back pain

Lower back pain is a difficult chronic condition that can affect your lifestyle and wellbeing in many ways. The most recent research suggests that NSAIDs can offer a moderate improvement in pain and function.

Musculoskeletal injuries

If you are experiencing a musculoskeletal injury (injury to a bone, joint, tendon or ligament), NSAIDs are a good option. Medical experts advise their use for the anti-inflammatory and pain-reducing effects for conditions such as tendon and ligament injuries, fractures, muscular injuries, and other musculoskeletal injuries.

You might be concerned about the anti-inflammatories effects of NSAIDs for the recovery of your musculoskeletal injuries. In recent years, research has suggested that inflammation is critical to the proper healing of damaged tissue and that the use of NSAIDs may ultimately prolong recovery. However, these claims have been primarily supported by laboratory experiments in mice but have NOT been supported by research in humans.

Research in humans shows that NSAIDs decrease your pain and lower inflammation and as long as they are used short term (< 1-2 weeks), and are unlikely to cause side effects. Furthermore, the pain relief experienced from NSAIDs allows for increased mobility and function of injuries which is critical to healing and recovery. Ultimately, NSAIDs are a great option for your pain management and recovery from a musculoskeletal injury. 

Arthritis

A common chronic musculoskeletal condition you might be experiencing is osteoarthritis (OA).

OA is a degenerative disease in which the cartilage, bone and ligaments that support joints, is broken down over time. The inflammation that results progresses the disease faster and causes joint pain. Both topical (cream) and oral (pill) NSAIDs, are extremely effective for OA as they block inflammation while providing pain relief. For this to happen, however, they must be used long term, and thus come with an increased risk of side effects.

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How to choose an NSAID

When choosing which NSAID is best for you, it is important to consider your illness, injury, and any pre-existing health conditions.

Advil (Ibuprofen) poses the lowest risk of side effects and is available at most pharmacies and groceries stores. Other NSAIDs may work better for specific illnesses or injuries, and you should consult a physician to learn if one may be the best option for you.

To target a specific area of pain, NSAIDs in cream form are highly effective. They can improve pain symptoms at the site of injury and because they are only applied to one area of the body, there is a lower risk of side effects.

Finally, if you suffer from certain pre-existing heart, gastrointestinal or kidney conditions, then NSAIDs may not be recommended. You should consult a physician to ensure that NSAIDs are safe for you.

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Overall, NSAIDs do not fully treat or cure any illness, injury or pain. However, their effects can make all of these conditions much more manageable, allowing you to get back to your normal life and enjoy the activities you love.

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Contributing Expert

Sam Hendry, University of British Columbia MD Program

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References