Non Steroidal Anti-Inflammatory Drugs
Non Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications which, as
well as having pain-relieving (analgesic) effects, have the effect of
reducing inflammation when used over a period of time.
Uses
NSAIDs can be used as simple pain killers (analgesics), but paracetamol
is usually preferable, as it is likely to have less unwanted effects,
and costs less. They are most useful in conditions which cause
inflammation. The anti-inflammatory effects may take from a few days to
three weeks to come on, so it is worth persevering for a while before
deciding that a NSAID is not going to help.
NSAIDs are used as follows:
- The commonest use of these drugs is for arthritis. Paracetamol
is often adequate for
osteoarthritis, but NSAIDs are particularly useful in the
inflammatory forms of arthritis (eg rheumatoid arthritis) and,
sometimes, in the more severe forms of osteoarthritis.
-
Back pain and
sciatica. Ibuprofen has been clearly demonstrated to be helpful,
and the other NSAIDs are also helpful.
-
Sprains, strains, and rheumatism.
- Dental pain.
- Post-operative pain.
- Period pain (dysmenorrhoea) and
heavy periods (menorrhagia).
- Pain from kidney stones (renal colic).
- To help reduce temperature in someone with a
fever.
-
Migraine.
- Other painful conditions, especially where there is
inflammation.
Properties
The NSAIDs work by affecting some chemicals in the body which cause
inflammation, the prostaglandins. Unfortunately the same group
of chemicals are involved in the stomach, and so the NSAIDs tend to
cause indigestion, and may even cause
duodenal or stomach ulceration.
As a result of this side-effect they cannot be used in someone with a
history of
peptic ulcer, except in exceptional circumstances, under close
medical supervision. Also they would rarely be used and, if used, only
with extra care, in somebody with
heartburn or indigestion.
In general, the more effective a NSAID is at reducing inflammation,
the more likely it is to cause indigestion. Sometimes your doctor will
prescribe them along with something to cut down the risk of ulceration.
There is even one medication that contains both components together.
There have been recent advances, in that some NSAIDs are said to be
more specific in dealing with inflammation and less likely to irritate
the digestive (gastro-intestinal) system, but nothing has yet overcome
this problem altogether.
The drugs vary in strength and side effects. Usually, as with other
medications, the more effective they are, the more
side-effects they are likely to have.
Aspirin, which originated from willow bark, has been around for a
long time and is in many people's medicine chests. This is an
anti-inflammatory analgesic. Most NSAIDs also reduce the temperature in
someone with a
fever.
Of the newer medications in this group, the one in widest general use
is Ibuprofen, which is available over the counter in many countries.
There are a large number of other NSAIDs, most of which have to be
obtained on prescription in the UK.
The one in most extensive use in UK, after Ibuprofen, is Diclofenac.
Adverse reactions
There are many other potential side effects, but these vary according to
the drug chosen and the individual taking it. The other side effects are
far less likely to occur.
Specific allergy to a NSAID can be quite dramatic, with rash,
swelling of the face, and sometimes difficulty breathing. (If this
happens you should call for help urgently.) As with other drugs, if you
get a reaction which you suspect to be a side effect, stop taking it and
check with your doctor. Sometimes, if the reaction involves an itchy
rash and or swelling, it is worth trying an
antihistamine in the meantime.
Some people with
asthma react to the NSAIDs by getting more wheezy. If this happens
you should stop the drug, and use your usual asthma medication, calling
the doctor if this does not work.
Warnings
NSAIDs cannot be used (are contraindicated)
in the following cases:
- Allergy to
aspirin or any NSAID
-
Aspirin should not be used under the age of 16 years
- During pregnancy
- During breast feeding
- On blood thinning agents (anticoagulants)
- Suffering from a defect of the blood clotting system
(coagulation)
- Active
peptic ulcer
Care is needed if you have:
-
Asthma
- Kidney impairment
- Heart impairment
- Liver impairment
These drugs are available in nearly every form:
- By mouth, they come in tablets, capsules or medicines.
This is the most widely used form.
- Some NSAIDs are available as injections. This form is
used for the pain after surgical operations and also is very
effective for the treatment of pain produced by kidney stones (renal
colic).
- Suppositories are available. These are often used for
post operative pain and sometimes in chronic pain when the patient
is unable to take medication by mouth.
- Creams, gels and foams to apply to the skin. These are
not felt to be as effective, but some people do get considerable
relief from their use.
Although non-oral routes of administration avoid the direct
irritation of the stomach, they do not avoid the indigestion and ulcer
risks, as these are caused by the chemical once it is in the blood
stream.
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