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NSAID

NSAIDs: non-steroidal anti-inflammatory drugs 

Because most episodes of back pain have inflammation as a contributing factor, anti-inflammatory medication such as non-steroidal anti-inflammatory drugs (NSAIDs) is often an effective treatment option. The types of NSAIDs reviewed on this page work like aspirin by limiting the formation of inflammation, but have fewer gastrointestinal side effects (such as gastritis or ulcers) than aspirin.

NSAIDs comprise a large class of drugs with many different options. All NSAIDs have similar effects and function but differ in dose frequency, side effects, and cost. All NSAIDs have potential effects on the stomach and gastro-intestinal lining and this class of medications should be avoided in persons with a ulcer or gastritis history. NSAIDs also need to be carefully considered in individuals with kidney problems.In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) NSAIDs and prescription brands of NSAIDs.

The three types of NSAIDs most commonly used to treat many types of back pain and neck pain include:

  1. Ibuprofen (e.g. brand names such as Advil, Motrin, Nuprin)
  2. Naproxen (e.g. brand names such as Aleve, Naprosyn)
  3. COX-2 inhibitors (e.g. brand names such as Celebrex)

The type of NSAID recommended will usually depend on a number of factors, including the patient’s diagnosis, clinical situation and level of pain, individual risk factors, and the patient’s past experience with particular medications.

Ibuprofen (e.g. Advil, Motrin, Nuprin) 
Ibuprofen was one of the original non-steroidal anti-inflammatory drugs and is available without a prescription. For patients with back problems, ibuprofen is most commonly recommended to relieve mild or moderate back pain, tenderness, inflammation, and stiffness. The typical recommended dose for ibuprofen is 400 mg taken every eight hours. Prescription doses can be as high as 800 mg of ibuprofen every eight hours.

Naproxen (e.g. Aleve, Naprosyn, Anaprox, Naprelan) 
Naproxen is available in both non-prescription strength (e.g. brand name Aleve) and prescription strength (e.g. brand name Naprosyn). For patients with back pain, it works by reducing proteins that cause inflammation and pain in the body and is commonly recommended for treatment of back pain.

Naproxen thins the blood, so individuals taking oral blood thinners or anticoagulants should avoid naproxen, as excessive blood thinning may lead to bleeding. Naproxen also can have some adverse gastrointestinal side effects, so people with active ulcers or sensitive stomachs should avoid it. It is best to take naproxen with food to reduce the chance of upset stomach. Notably, naproxen has a potentially fatal interaction with MAOI drugs (e.g. Marplan, Nardil). The usual adult dose is 250 to 500 mg twice daily using regular naproxen tablets.

COX-2 inhibitors (e.g. prescription brand Celebrex) 
This is a newer class of NSAID that works by stopping the chemical reaction that leads to inflammation in the body, but (unlike other NSAIDs) does not harm the chemical production of the protective stomach lining. Therefore, COX-2 inhibitors lead to a lower gastrointestinal complication rate than other NSAIDs and do not tend to produce ulcers.

Also unlike other NSAIDs, COX-2 inhibitors do not impair blood clotting, so they are considered safer for patients taking blood thinning medications, such as warfarin (e.g. Coumadin), and they may be used before or after surgery without an increased risk of bleeding.

Important new information from recent studies shows a potentially increased risk for cardiovascular events (such as heart attack and stroke) for  all NSAIDs, and the FDA has called for further research. Patients taking NSAIDs should meet with their physician to determine their individual risk factors and appropriate treatment options.

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