Table of ContentsView AllTable of ContentsNSAID Side EffectsNSAIDs and Heart RisksSafer NSAID AlternativesFrequently Asked Questions
Table of ContentsView All
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Table of Contents
NSAID Side Effects
NSAIDs and Heart Risks
Safer NSAID Alternatives
Frequently Asked Questions
Nonsteroidal anti-inflammatory drugs(NSAIDs) are commonly used to treat acute and chronic pain associated with conditions like arthritis. It is also used to reduce fevers and inflammations. They can also prevent blood from clotting. The most common over-the-counter NSAIDs include ibuprofen, aspirin, and naproxen.
These medications are not without side effects, however. Non-aspirin NSAIDs have been associated with an increased risk forheart attack,stroke,heart failure, and death from cardiovascular disease.Other common side effects include stomach pain, gas, bloating, and nausea. NSAIDs may also interfere with kidney function.
NSAIDs for Chronic Pain: Risks of Long-Term Use
Verywell / Laura Porter
You may experience side effects if you take a large amount of NSAIDs or use the medications long-term. Some side effects are mild and will disappear on its own, while others require medical attention to resolve.
The most commonly reported side effects of NSAID use include:
To relieve gastrointestinal discomfort and symptoms, healthcare providers recommend taking NSAIDs with food, milk, or antacids.Unless your healthcare provider tells you to do so, don’t take an over-the-counter NSAID with a prescription NSAID, multiple over-the-counter NSAIDs, or more than the recommended dose of an NSAID. Doing so could increase your risk of side effects.
This risk of side effects may be greater in people who:
If you experience any severe stomach pain, black stools, bloody urine, blurred vision, chest pain, back pain, hearing problems, and allergic reactions, call your healthcare provider immediately.
NSAID Safety Tips
If you are taking NSAIDs (prescription or over-the-counter), safety guidelines are as follows:
Although the reasons for the connection between NSAIDs and heart risks are not fully understood, there is sufficient proof for caution, specifically if your chance of heart disease is increased due to age, excessive weight, smoking,high-cholesterol,blood pressure, or a prior heart attack or stroke.The U.S. Food and Drug Administration requires that these risks be clearly outlined in the label of these medications.
For those at above-average risk for heart problems or have multiple risk factors and take NSAIDs such as diclofenac, celecoxib or ibuprofen, seven to eight cardiovascular episodes would take place per 1000 people who take these drugs. However, research indicates that naproxen shows the smallest risk compared with other NSAIDS.
Low-Dose Aspirin safetyLow-dose aspirin thins the blood, which is typically prescribed to prevent heart attacks or strokes for individuals who are at high risk of heart attacks. Before you go on a low-dose aspirin treatment plan, speak to your healthcare provider if you’ve experienced ulcers, indigestion, gout, or have high blood pressure, heavy periods, asthma or lung disease, a blood clotting problem to determine if low-dose aspirin is safe for you.In addition, some medicines (other painkillers like ibuprofen), vitamins, and herbal remedies may interfere with low-dose aspirin and increase the risk of side effects. Speak with your healthcare provider or pharmacist if you are uncertain about taking these drugs and supplements with low-dose aspirin.
Low-Dose Aspirin safety
Low-dose aspirin thins the blood, which is typically prescribed to prevent heart attacks or strokes for individuals who are at high risk of heart attacks. Before you go on a low-dose aspirin treatment plan, speak to your healthcare provider if you’ve experienced ulcers, indigestion, gout, or have high blood pressure, heavy periods, asthma or lung disease, a blood clotting problem to determine if low-dose aspirin is safe for you.In addition, some medicines (other painkillers like ibuprofen), vitamins, and herbal remedies may interfere with low-dose aspirin and increase the risk of side effects. Speak with your healthcare provider or pharmacist if you are uncertain about taking these drugs and supplements with low-dose aspirin.
Low-dose aspirin thins the blood, which is typically prescribed to prevent heart attacks or strokes for individuals who are at high risk of heart attacks. Before you go on a low-dose aspirin treatment plan, speak to your healthcare provider if you’ve experienced ulcers, indigestion, gout, or have high blood pressure, heavy periods, asthma or lung disease, a blood clotting problem to determine if low-dose aspirin is safe for you.
In addition, some medicines (other painkillers like ibuprofen), vitamins, and herbal remedies may interfere with low-dose aspirin and increase the risk of side effects. Speak with your healthcare provider or pharmacist if you are uncertain about taking these drugs and supplements with low-dose aspirin.
Due to the side effects of NSAIDs, many people are investigating alternatives that can help relieve pain and inflammation, including topical NSAIDs, acetaminophen, nonacetylated salicylates, as well as herbal remedies and dietary supplements, yoga, and acupuncture.
Acetaminophen
Common Medications for Lower Back Pain Relief
Topical NSAIDs
Topical NSAIDs have comparable effects on acute muscular and joint pain with a lower risk of side effects, specifically gastrointestinal ones.Topical NSAIDs are not absorbed into the blood to the same extent as oral NSAIDs, and people who use the topical form have lower peak blood levels of the medications and fewer adverse effects when using topical formulations compared with pills. Topical NSAIDs are said to be better for localized pain near the surface of the skin, such as pain in the hands and knees. One study found that topical NSAIDs offer relief for a minority of people with osteoarthritis.
For patients with a history of gastrointestinal bleeding or chronic kidney disease, topical NSAIDs have shown they provide relief and that adverse side effects were rare.People who use topical NSAIDs should closely following the dosing instructions from their healthcare providers, however, especially those who had previous adverse reactions to NSAIDs.
Topical Relief for Muscle Pain
Nonacetylated Salicylates
If you’re concerned with gastrointestinal damage and bleeding and want to avoid aspirin, you may want to try nonacetylated salicylates. They are more potent than acetaminophen but much less than aspirin. These drugs reduce pain and inflammation but will do less damage to your stomach or prompt excessive bleeding.Unlike aspirin, nonacetylated salicylates do not have cardiovascular protective benefits.
Safer Alternatives to NSAIDs
Arnica
Arnicais an herb found primarily in Siberia and in parts of Central Europe and North America. The flowers are used for medicinal purposes to alleviate pain from osteoarthritis, sore throat, surgery, and other ailments. Arnica is commonly used for bruising, bleeding, and swelling. However, there is no scientific evidence that supports its efficacy for these conditions.
Curcumin
Curcuminis derived from turmeric, a relative of the ginger family. It has been used in both Ayurvedic and Chinese medicines to reduce inflammation, as well as to treat digestive disorders and for wound healing.
Standard dosage for turmeric powder is 400–600 mg taken three times per day. Side effects are few, but can cause an upset stomach, and, on rare occasions, gastric ulcers may occur if you’re taking a high dose. If you are taking anticoagulant medications or high doses of NSAIDs, caution is needed because turmeric can also slow blood clotting.
Bromelain
Bromelainis a supplement for reducing pain and swelling in the nose, sinuses, gums, and other parts of the body after surgery or an injury. It is used for osteoarthritis, cancer, digestive problems, and muscle soreness. Its topical form is used for burns.
Research indicates that there is conflicting information regarding whether Bromelain alone or combined with other substances relieves osteoarthritis pain or post-exercise muscle soreness.
Topical Capsaicin
Capsaicin comes in various topical forms for the skin such as as an ointment, cream, gel, oil, and in several strengths. Inform your healthcare provider or pharmacist of other prescriptions you may be taking and any vitamins, supplements, and herbal products.
Acupuncture
Acupuncture is a technique used in traditional Chinese medicine. By inserting fine needles into certain areas on your body, acupuncture can stimulate specific points to help relieve pain or other conditions. Research indicates that acupuncture may help alleviate chronic pain in the lower back, neck, knees and for individuals with osteoarthritis. Acupuncture can have a number of serious side effects if not properly executed. These include punctured organs, infections from non-sterilized needles, collapsed lungs, and damage to the central nervous system.
Yoga for Pain
Research indicates thatyogamay help with relieving pain for certain conditions. For fibromyalgia, certain symptoms may be alleviated with yoga and other forms of exercise like muscle strength training, massage, and acupuncture. A 2020 review of 25 randomized controlled trials looked into its effect on back pain. Twenty studies indicated positive results in pain, depression, and anxiety. However, there was no discernible difference in pain after six weeks of yoga versus physical therapy.
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A Word From Verywell
No one wants to be in pain, whether it’s from a mild headache or after a surgical procedure. NSAIDs have helped millions of people cope with their pain, but they do come with side effects that can develop into serious health problems. Be aware of the side effects, and let your healthcare provider know what other medications you’re taking so they can prescribe the appropriate dosage. And remember to notify your healthcare provider right away about any side effects you are experiencing so they can either modify the dose or prescribe a different medication to alleviate your pain.
Frequently Asked QuestionsYes, you can be allergic to ibuprofen or other NSAIDs. A person can also develop a hypersensitivity to NSAIDs that is similar to an allergic reaction.Signs of an allergy or hypersensitivity to NSAIDs include:Chest tightness, coughing, or wheezingHivesItchingNasal congestion or runny noseRed or watering eyesSkin flushingMaybe, but you should discuss it with your doctor. People who have an allergic reaction or hypersensitivity to one type of NSAID are at greater risk for having a cross-reaction. Some people who are allergic to ibuprofen do not have a reaction when taking another NSAID.If you are allergic to any NSAID, talk to your doctor before trying a different NSAID. They may recommend you first take it in the office under medical supervision to see if you have a reaction. In addition, your doctor will likely order you an EpiPen to use in case of a reaction.In addition to being allergic or hypersensitive to NSAIDs, the medications can have uncomfortable side effects that include stomach pain, gas, bloating, and nausea. In addition, certain NSAIDs may increase your risk for heart attack, stroke, heart failure, and death from cardiovascular disease.Acetaminophen is a safe alternative to NSAIDs for people who are allergic or hypersensitive to ibuprofen or other NSAIDs. In addition, certain supplements can help provide relief from inflammation and pain. Common alternatives to NSAIDs include arnica, curcumin, and bromelain. Topical pain reliers—like capsaicin cream—may also help to provide relief.
Yes, you can be allergic to ibuprofen or other NSAIDs. A person can also develop a hypersensitivity to NSAIDs that is similar to an allergic reaction.Signs of an allergy or hypersensitivity to NSAIDs include:Chest tightness, coughing, or wheezingHivesItchingNasal congestion or runny noseRed or watering eyesSkin flushing
Yes, you can be allergic to ibuprofen or other NSAIDs. A person can also develop a hypersensitivity to NSAIDs that is similar to an allergic reaction.
Maybe, but you should discuss it with your doctor. People who have an allergic reaction or hypersensitivity to one type of NSAID are at greater risk for having a cross-reaction. Some people who are allergic to ibuprofen do not have a reaction when taking another NSAID.If you are allergic to any NSAID, talk to your doctor before trying a different NSAID. They may recommend you first take it in the office under medical supervision to see if you have a reaction. In addition, your doctor will likely order you an EpiPen to use in case of a reaction.
Maybe, but you should discuss it with your doctor. People who have an allergic reaction or hypersensitivity to one type of NSAID are at greater risk for having a cross-reaction. Some people who are allergic to ibuprofen do not have a reaction when taking another NSAID.
If you are allergic to any NSAID, talk to your doctor before trying a different NSAID. They may recommend you first take it in the office under medical supervision to see if you have a reaction. In addition, your doctor will likely order you an EpiPen to use in case of a reaction.
In addition to being allergic or hypersensitive to NSAIDs, the medications can have uncomfortable side effects that include stomach pain, gas, bloating, and nausea. In addition, certain NSAIDs may increase your risk for heart attack, stroke, heart failure, and death from cardiovascular disease.
Acetaminophen is a safe alternative to NSAIDs for people who are allergic or hypersensitive to ibuprofen or other NSAIDs. In addition, certain supplements can help provide relief from inflammation and pain. Common alternatives to NSAIDs include arnica, curcumin, and bromelain. Topical pain reliers—like capsaicin cream—may also help to provide relief.
19 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Orthoinfo.What are NSAIDs?Cleveland Clinic.Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).Arthritis Foundation.NSAIDs.Arthritis Foundation.NSAIDs and the Risk of Problems and Stroke.Varga Z, Sabzwari SRA, Vargova V.Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.Cureus. 2017 Apr 8;9(4):e1144. doi: 10.7759/cureus.1144Harvard Health.Heart-Safer NSAID Alternative.NHS UK.Aspirin: Low Dose to Prevent Heart Attacks and Stroke.MedlinePlus.Acetaminophen.Klinge SA, Sawyer GA.Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: a comprehensive review.Phys Sportsmed. 2013 May;41(2):64-74. doi: 10.3810/psm.2013.05.2016Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA.Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2016 Apr 22;4(4):CD007400. doi: 10.1002/14651858.CD007400.pub3Rogers NV, Rowland K.An Alternative to Oral NSAIDs for Acute Musculoskeletal Injuries.J Fam Pract. 2011 Mar;60(3):147-8. PMID: 21369556; PMCID: PMC3183960.Medlineplus.Arnica.Maroon JC, Bost JW, Maroon A.Natural Anti-Inflammatory Agents for Pain Relief.Surg Neurol Int.2010;1. DOI: 10.4103/2152-7806.73804National Center for Complementary and Integrative Health.Bromelain.Fattori V, Hohmann MSN, Rossaneis AC, Pinho-Ribeiro FA, Verri WA.Capsaicin: Current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses.Molecules. 2016;21(7). doi:10.3390/molecules21070844MedlinePlus.Capsaicin Topical.National Center for Complementary and Integrative Health.Acupuncture.National Center for Complementary and Integrative Health.Yoga for Pain: What the Science Says.Kowalski ML, Makowska JS.Seven steps to the diagnosis of NSAIDs hypersensitivity: how to apply a new classification in real practice?Allergy Asthma Immunol Res. 2015;7(4):312–20. doi:10.4168/aair.2015.7.4.312
19 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Orthoinfo.What are NSAIDs?Cleveland Clinic.Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).Arthritis Foundation.NSAIDs.Arthritis Foundation.NSAIDs and the Risk of Problems and Stroke.Varga Z, Sabzwari SRA, Vargova V.Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.Cureus. 2017 Apr 8;9(4):e1144. doi: 10.7759/cureus.1144Harvard Health.Heart-Safer NSAID Alternative.NHS UK.Aspirin: Low Dose to Prevent Heart Attacks and Stroke.MedlinePlus.Acetaminophen.Klinge SA, Sawyer GA.Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: a comprehensive review.Phys Sportsmed. 2013 May;41(2):64-74. doi: 10.3810/psm.2013.05.2016Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA.Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2016 Apr 22;4(4):CD007400. doi: 10.1002/14651858.CD007400.pub3Rogers NV, Rowland K.An Alternative to Oral NSAIDs for Acute Musculoskeletal Injuries.J Fam Pract. 2011 Mar;60(3):147-8. PMID: 21369556; PMCID: PMC3183960.Medlineplus.Arnica.Maroon JC, Bost JW, Maroon A.Natural Anti-Inflammatory Agents for Pain Relief.Surg Neurol Int.2010;1. DOI: 10.4103/2152-7806.73804National Center for Complementary and Integrative Health.Bromelain.Fattori V, Hohmann MSN, Rossaneis AC, Pinho-Ribeiro FA, Verri WA.Capsaicin: Current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses.Molecules. 2016;21(7). doi:10.3390/molecules21070844MedlinePlus.Capsaicin Topical.National Center for Complementary and Integrative Health.Acupuncture.National Center for Complementary and Integrative Health.Yoga for Pain: What the Science Says.Kowalski ML, Makowska JS.Seven steps to the diagnosis of NSAIDs hypersensitivity: how to apply a new classification in real practice?Allergy Asthma Immunol Res. 2015;7(4):312–20. doi:10.4168/aair.2015.7.4.312
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Orthoinfo.What are NSAIDs?Cleveland Clinic.Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).Arthritis Foundation.NSAIDs.Arthritis Foundation.NSAIDs and the Risk of Problems and Stroke.Varga Z, Sabzwari SRA, Vargova V.Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.Cureus. 2017 Apr 8;9(4):e1144. doi: 10.7759/cureus.1144Harvard Health.Heart-Safer NSAID Alternative.NHS UK.Aspirin: Low Dose to Prevent Heart Attacks and Stroke.MedlinePlus.Acetaminophen.Klinge SA, Sawyer GA.Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: a comprehensive review.Phys Sportsmed. 2013 May;41(2):64-74. doi: 10.3810/psm.2013.05.2016Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA.Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2016 Apr 22;4(4):CD007400. doi: 10.1002/14651858.CD007400.pub3Rogers NV, Rowland K.An Alternative to Oral NSAIDs for Acute Musculoskeletal Injuries.J Fam Pract. 2011 Mar;60(3):147-8. PMID: 21369556; PMCID: PMC3183960.Medlineplus.Arnica.Maroon JC, Bost JW, Maroon A.Natural Anti-Inflammatory Agents for Pain Relief.Surg Neurol Int.2010;1. DOI: 10.4103/2152-7806.73804National Center for Complementary and Integrative Health.Bromelain.Fattori V, Hohmann MSN, Rossaneis AC, Pinho-Ribeiro FA, Verri WA.Capsaicin: Current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses.Molecules. 2016;21(7). doi:10.3390/molecules21070844MedlinePlus.Capsaicin Topical.National Center for Complementary and Integrative Health.Acupuncture.National Center for Complementary and Integrative Health.Yoga for Pain: What the Science Says.Kowalski ML, Makowska JS.Seven steps to the diagnosis of NSAIDs hypersensitivity: how to apply a new classification in real practice?Allergy Asthma Immunol Res. 2015;7(4):312–20. doi:10.4168/aair.2015.7.4.312
Orthoinfo.What are NSAIDs?
Cleveland Clinic.Non-Steroidal Anti-Inflammatory Drugs (NSAIDs).
Arthritis Foundation.NSAIDs.
Arthritis Foundation.NSAIDs and the Risk of Problems and Stroke.
Varga Z, Sabzwari SRA, Vargova V.Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.Cureus. 2017 Apr 8;9(4):e1144. doi: 10.7759/cureus.1144
Harvard Health.Heart-Safer NSAID Alternative.
NHS UK.Aspirin: Low Dose to Prevent Heart Attacks and Stroke.
MedlinePlus.Acetaminophen.
Klinge SA, Sawyer GA.Effectiveness and safety of topical versus oral nonsteroidal anti-inflammatory drugs: a comprehensive review.Phys Sportsmed. 2013 May;41(2):64-74. doi: 10.3810/psm.2013.05.2016
Derry S, Conaghan P, Da Silva JA, Wiffen PJ, Moore RA.Topical NSAIDs for chronic musculoskeletal pain in adults.Cochrane Database Syst Rev. 2016 Apr 22;4(4):CD007400. doi: 10.1002/14651858.CD007400.pub3
Rogers NV, Rowland K.An Alternative to Oral NSAIDs for Acute Musculoskeletal Injuries.J Fam Pract. 2011 Mar;60(3):147-8. PMID: 21369556; PMCID: PMC3183960.
Medlineplus.Arnica.
Maroon JC, Bost JW, Maroon A.Natural Anti-Inflammatory Agents for Pain Relief.Surg Neurol Int.2010;1. DOI: 10.4103/2152-7806.73804
National Center for Complementary and Integrative Health.Bromelain.
Fattori V, Hohmann MSN, Rossaneis AC, Pinho-Ribeiro FA, Verri WA.Capsaicin: Current understanding of its mechanisms and therapy of pain and other pre-clinical and clinical uses.Molecules. 2016;21(7). doi:10.3390/molecules21070844
MedlinePlus.Capsaicin Topical.
National Center for Complementary and Integrative Health.Acupuncture.
National Center for Complementary and Integrative Health.Yoga for Pain: What the Science Says.
Kowalski ML, Makowska JS.Seven steps to the diagnosis of NSAIDs hypersensitivity: how to apply a new classification in real practice?Allergy Asthma Immunol Res. 2015;7(4):312–20. doi:10.4168/aair.2015.7.4.312
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