Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective in relieving many types of pain and inflammation. Millions of people use NSAIDs daily for various reasons, making them among the most commonly used drugs in the world. However, NSAIDs are usually not appropriate for people with stomach problems because they may have a higher risk for stomach bleeding. Furthermore, the U.S. Food and Drug Administration (FDA) recently strengthened its warnings about cardiac risks pertaining to their use.

NSAIDs can either be prescribed or bought over the counter. They come in several forms, including:

• Oral (pills, tablets, capsules, caplets, gum)
• Topical (creams, lotions, gels, patches)
• Liquid, including eye drops for eye pain
• Injection:
  
  
• Systemic (affects the entire body), or
• Localized (affects one area of the body)

NSAIDs prevent inflammation by slowing the production of prostaglandins (chemical messengers) in the body. Prostaglandins play a key role in the cause of swelling, pain, stiffness, redness and warmth. NSAIDs, sometimes called anti–prostaglandins, are administered in low doses to prevent pain. Higher doses are commonly used to reduce inflammation.

Prostaglandins also protect the lining of the stomach from stomach acid. Because NSAIDs decrease prostaglandin production, the stomach lining is more susceptible to irritation or ulcers when a person takes an NSAID. To minimize this risk, some NSAIDs have a special coating. Prescription or over-the-counter antacids or taking NSAIDs with milk or food may help reduce the risk of ulcers.

Where appropriate, newer ways of delivering NSAIDs can target delivery and avert gastric upset. Examples of topically applied NSAIDs include gel rubbed into an osteoarthritic knee or a patch applied to an elbow with tendinitis.

NSAIDs are used frequently to alleviate pain and inflammation. There are also other many types of pain relievers (analgesics) that are not NSAIDs, such as acetaminophen. NSAIDs usually take four to 24 hours to be effective, although as many as three weeks of continuous use may be necessary for maximum benefit.

NSAIDs can cause serious side effects and are not always appropriate for pain sufferers. Therefore, it is recommended that patients consult their physician before using these drugs. Often an alternate drug can be effectively substituted.

A specific type of NSAID known as COX-2 inhibitors was used to treat individuals who had stomach sensitivity to traditional NSAIDs. They were thought to treat pain and inflammation as effectively as traditional NSAIDs, but without many of the gastric side effects. However, recent data released by the FDA confirms that certain NSAIDs – notably some COX-2 inhibitors – may increase the risk of cardiovascular events. As a result of these findings, two of the three available COX–2 inhibitors have been withdrawn from the market.

The FDA advised in 2005 that:

• All NSAIDs except aspirin increase the risk of serious adverse cardiovascular events (e.g., heart attack or stroke).
  
  
• All NSAIDs including aspirin increase the risk of serious and potentially life-threatening gastrointestinal bleeding.
  
  
• NSAIDs should not be given to patients immediately after a coronary artery bypass graft.

The National Institutes of Health (NIH) cautions about two forms of kidney disease that can result from use of over-the-counter pain drugs including NSAIDs:

• Sudden-onset acute kidney failure can occur in people with risk factors including old age, chronic kidney disease, systemic lupus erythematosus or alcohol abuse.
  
  
• Chronic kidney damage (analgesic nephropathy) can develop in anyone taking these drugs daily over several years.

Patients should discuss the potential risks of NSAIDs with their physician before using them.