NSAIDs (Non-Steroidal Anti-inflammatory Drugs)

Because many orthopaedic conditions—whether due to acute injury or chronic issues like arthritis—involve inflammation, I find myself talking to people about “anti-inflamatories” many times each day. 

What is an NSAID? NSAID stands for non-steroidal anti-inflammatory drug.  NSAIDs such as aspirin and ibuprofen can decrease inflammation, lower fevers, relieve pain, or prevent blood clotting. 

How do NSAIDs work?  An enzyme in your body called cyclooxygenase (COX) has two forms.  COX-1 protects the stomach lining from acid; COX-2 is produced with joint inflammation.  NSAIDs interrupt both forms of COX, which means that they decrease musculoskeletal pain and inflammation, but also can cause stomach upset or ulceration.  Aspirin, ibuprofen (Advil or Motrin), naproxen (Aleve or Naprosyn), and nabumetone (Relafen) are NSAIDs.  Ask your doctor which and what dose to use, and remember that different NSAIDs might work better for you than others.


What are the COX-2 inhibitors?  A special kind of NSAID blocks only the inflammatory COX-2, and does not inhibit the protective effect on the stomach.  Although Vioxx and Bextra were withdrawn from the market by their manufacturer, Celebrex (celecoxib) still is available by prescription.  These should not be used with other NSAIDs, and make sure you talk to your doctor, particularly if you have a history of heart attack, stroke, angina (chest pain), high blood pressure, blood clots, or problems taking sulfa drugs, aspirin, or other NSAIDs.


What are the risks of taking NSAIDs? Because they can interfere with blood clotting, easy bruising can occur.  More importantly, they can contribute to developing nausea or ulcers and can interfere with kidney function.  Discuss use with your doctor if you have high blood pressure, asthma, a history of kidney or liver problems, a history of ulcers, if you are over 65 years old, or if you are pregnant.  Find out whether NSAIDs will interfere with any medications you currently are taking.

As always, talk to your doctor before starting any new medications, and keep an open mind: we recommend anti-inflammatories because they work!