Non-steroidal anti-inflammatory (NSAID) medications are often a first-line recommendation for over-the-counter (OTC) pain management. They can treat aches and pains from illness, headaches, menstrual cramps, and other common conditions. Individuals with irritable bowel disease (IBD) may experience pain daily due to their IBD or extra-intestinal conditions such as arthritis.
However, somegastroenterologistsrecommend that IBD patients stay away from NSAIDs. The reason is because NSAIDs can cause damage to the mucosal lining of the gastrointestinal (GI) tract.Generally, NSAIDs and Crohn’s disease don’t mix well. While they may be okay sometimes, several alternatives exist.
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NSAIDs and the GI Tract
NSAIDs block two particular enzymes in the body:cyclooxygenase-1(COX-1) andcyclooxygenase-2(COX-2). COX-1 plays a role in the digestive system, and COX-2 in the inflammatory process.
NSAIDs typically aren’t great at only blocking COX-2, which is responsible for pain and inflammation. Most also block COX-1, which plays a role in gut protection. Some prescription NSAIDs are more specific to COX-2 and may do less damage to the GI tract.
So, whileNSAIDs reduce inflammation and pain, they also cause the digestive system to lose some of its normal protective substances (e.g., prostaglandins). This can be especially problematic for people with pre-existing inflammation or the potential for inflammation in their digestive tract, such as those with IBD.
In addition to their role as COX inhibitors, other mechanisms of NSAIDs can further damage the GI tract. NSAIDs may directly impact the protective mucosal layer of the GI tract and negatively affect its metabolism.
Do NSAIDs Cause IBD?
While NSAIDs don’t cause IBD, they can cause ulcers and mimic IBD, such as Crohn’s disease.
Even in people without IBD, NSAIDs can contribute toulcersin both the stomach and the first part of thesmall intestine(called theduodenum). Additionally, NSAIDs can cause inflammation and worsen bleeding in the small intestine.
It is estimated that up to 70% of individuals who regularly use NSAIDs for an extended period have inflammation in the small intestine. Up to 30% of long-term NSAID users may experience ulcers or erosions.
Even short-term users are at risk of adverse GI effects, with studies finding that anywhere from 5%-80% of short-term NSAID users developed gastroduodenal ulcers.
Since NSAIDs are known to irritate the GI tract, they are a medication that is generally avoided in individuals withCrohn’s disease and IBD. Even if the NSAID doesn’t cause a true Crohn’s or IBD flare, the intestinal damage can feel like one.
Can People With IBD Take NSAIDs?
Generally, it is not recommended that individuals with IBD take NSAIDs, especially at higher doses and for an extended time. However, if it is at a lower dose and for a short period (e.g., a few days or a week), then it might be acceptable.
Additionally, COX-2 inhibitors tend to be more specific to inflammation without inhibiting protective prostaglandins. If an individual with Crohn’s disease or other form of IBD needs pain control due to inflammation (e.g., for arthritis), aCOX-2 inhibitor NSAIDis likely a safer anti-inflammatory medication.
COX-2 inhibitors are available only with a prescription. Celecoxib (brand name Celebrex) is the COX-2 inhibitor available in the United States.
If you have IBD and need pain relief, check with your healthcare provider about which medication options are appropriate for you.
List of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Several NSAIDs are available, both OTC and with a prescription. Below is a table with several NSAIDs listed. It is not an exhaustive list. If you have IBD or are concerned about the side effects of NSAIDs, contact your healthcare provider.
Alternatives to NSAIDs
People who have IBD and are looking for over-the-counter pain relief for pain that is unrelated to their IBD may wish to consider acetaminophen. Acetaminophen, sold under many brand names, including Tylenol, is not an NSAID and is typically a better choice for people with IBD who need a pain reliever.
However, whileacetaminophen can help reduce pain, it does not decrease inflammation. So, those with inflammatory pain conditions may require additional treatment.
Many individuals with IBD also experience comorbid autoimmune inflammatory conditions such asrheumatoid arthritisandankylosing spondylitis.These are both painful conditions andaminosalicylates, primarily sulfasalazine, can sometimes reduce inflammation and the associated inflammatory pain.
Prescriptionaminosalicylatesare also sometimes a treatment option for those with Crohn’s and IBD. The main aminosalicylate used is sulfasalazine. Sulfasalazine is an effective treatment for ulcerative colitis but is not regularly used for Crohn’s disease anymore.
Aside from ulcerative colitis, sulfasalazine is used to treat the following conditions:
However,sulfasalazinedoes need to be taken for an extended period to be effective, and many individuals experience side effects.
For pain related to Crohn’s and IBD, other treatment options may include:
Your provider may suggest one or several of these treatment options to help manage chronic pain related to IBD.
Summary
If you have Crohn’s disease or another form of IBD, your healthcare provider may recommend you try pain medications that are not NSAIDs. Even in individuals who do not have IBD, NSAIDs can cause GI side effects such as ulcers and mimic IBD. In most situations, your healthcare provider will likely recommend acetaminophen (e.g., Tylenol) over an OTC NSAID.
However, if you need additional pain relief for an acute condition, such as a headache, your provider may tell you it is ok to take a low dose of an NSAID for a short period.
If you have an additional autoimmune condition, such as rheumatoid arthritis or ankylosing spondylitis, that may present comorbidly with IBD, there are effective anti-inflammatory treatment options that are not NSAIDs.
If you experience chronic pain or pain related to your IBD, several non-NSAID treatments exist, such as low-dose antidepressants, mental health therapies, and antispasmodics, as well as additional options. Contact your healthcare provider for advice so they can tailor a pain management treatment plan to your specific needs.
8 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.Bergenstock M, McKee J, Johal A.NSAID-Induced Colitis Masquerading as Fistulizing Crohn’s Disease: 1484.American Journal of Gastroenterology.2018;113:(S852).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514.Ahluwalia A, Hoa N, Jones MK, Tarnawski AS.NSAID-induced injury of gastric epithelial cells is reversible: roles of mitochondria, AMP kinase, NGF, and PGE2.Am J Physiol Gastrointest Liver Physiol. 2019;317(6):G862-G871.Hijos-Mallada G, Sostres C, Gomollón F.NSAIDs, gastrointestinal toxicity and inflammatory bowel disease.Gastroenterol Hepatol. 2022;45(3):215-222.Chen Y, Chen L, Xing C, et al.The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis.BMC Gastroenterology. 2020;20:192.Rudwaleit M, Baeten D.Ankylosing spondylitis and bowel disease.Best Pract Res Clin Rheumatol. 2006;20(3):451-471.UpToDate.Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics).Baillie S, Norton C, Saxena S, Pollok R.Chronic abdominal pain in inflammatory bowel disease: a practical guide.Frontline Gastroenterology. 2024;15(2):144-153.Additional ReadingKefalakes H, Stylianides TJ, Amanakis G, Kolios G.Exacerbation of Inflammatory Bowel Diseases Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs: Myth or Reality?.Eur J Clin Pharmacol. 2009;65(10):963-70. doi: 10.1007/s00228-009-0719-3.Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS.Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.J Clin Gastroenterol. 2016;50(2):152-6. doi: 10.1097/MCG.0000000000000421.Mahadevan U, Loftus EV, Tremaine WJ, Sandborn WJ.Safety of Selective Cyclooxygenase-2 Inhibitors in Inflammatory Bowel Disease.Am J Gastroenterol. 2002;97(4):910-4. doi:10.1111/j.1572-0241.2002.05608.x.Matuk R, Crawford J, Abreu MT, Targan SR, Vasiliauskas EA, Papadakis KA.The Spectrum of Gastrointestinal Toxicity and Effect on Disease Activity of Selective Cyclooxygenase-2 Inhibitors in Patients With Inflammatory Bowel Disease.Inflamm Bowel Dis. 2004;10(4):352-6.https://doi.org/10.1097/00054725-200407000-00005.Ribaldone DG, Fagoonee S, Astegiano M, et al.Coxib’s Safety in Patients With Inflammatory Bowel Diseases: A Meta-Analysis.Pain Physician. 2015;18(6):599-607.Sandborn WJ, Stenson WF, Brynskov J, et al.Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study.Clin Gastroenterol Hepatol2006 Feb;4: 203-2011.Singh S, Graff LA, Bernstein CN.Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?Am J Gastroenterol2009; 104:1298–1313.Takeuchi K, Smale S, Premchand P, et al. “Prevalence and Mechanism of Nonsteroidal Anti-inflammatory Drug-Induced Clinical Relapse in Patients with Inflammatory Bowel Disease.“Clin Gastroenterol Hepatol. 2006 Feb;4:196-202.
8 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.Bergenstock M, McKee J, Johal A.NSAID-Induced Colitis Masquerading as Fistulizing Crohn’s Disease: 1484.American Journal of Gastroenterology.2018;113:(S852).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514.Ahluwalia A, Hoa N, Jones MK, Tarnawski AS.NSAID-induced injury of gastric epithelial cells is reversible: roles of mitochondria, AMP kinase, NGF, and PGE2.Am J Physiol Gastrointest Liver Physiol. 2019;317(6):G862-G871.Hijos-Mallada G, Sostres C, Gomollón F.NSAIDs, gastrointestinal toxicity and inflammatory bowel disease.Gastroenterol Hepatol. 2022;45(3):215-222.Chen Y, Chen L, Xing C, et al.The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis.BMC Gastroenterology. 2020;20:192.Rudwaleit M, Baeten D.Ankylosing spondylitis and bowel disease.Best Pract Res Clin Rheumatol. 2006;20(3):451-471.UpToDate.Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics).Baillie S, Norton C, Saxena S, Pollok R.Chronic abdominal pain in inflammatory bowel disease: a practical guide.Frontline Gastroenterology. 2024;15(2):144-153.Additional ReadingKefalakes H, Stylianides TJ, Amanakis G, Kolios G.Exacerbation of Inflammatory Bowel Diseases Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs: Myth or Reality?.Eur J Clin Pharmacol. 2009;65(10):963-70. doi: 10.1007/s00228-009-0719-3.Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS.Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.J Clin Gastroenterol. 2016;50(2):152-6. doi: 10.1097/MCG.0000000000000421.Mahadevan U, Loftus EV, Tremaine WJ, Sandborn WJ.Safety of Selective Cyclooxygenase-2 Inhibitors in Inflammatory Bowel Disease.Am J Gastroenterol. 2002;97(4):910-4. doi:10.1111/j.1572-0241.2002.05608.x.Matuk R, Crawford J, Abreu MT, Targan SR, Vasiliauskas EA, Papadakis KA.The Spectrum of Gastrointestinal Toxicity and Effect on Disease Activity of Selective Cyclooxygenase-2 Inhibitors in Patients With Inflammatory Bowel Disease.Inflamm Bowel Dis. 2004;10(4):352-6.https://doi.org/10.1097/00054725-200407000-00005.Ribaldone DG, Fagoonee S, Astegiano M, et al.Coxib’s Safety in Patients With Inflammatory Bowel Diseases: A Meta-Analysis.Pain Physician. 2015;18(6):599-607.Sandborn WJ, Stenson WF, Brynskov J, et al.Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study.Clin Gastroenterol Hepatol2006 Feb;4: 203-2011.Singh S, Graff LA, Bernstein CN.Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?Am J Gastroenterol2009; 104:1298–1313.Takeuchi K, Smale S, Premchand P, et al. “Prevalence and Mechanism of Nonsteroidal Anti-inflammatory Drug-Induced Clinical Relapse in Patients with Inflammatory Bowel Disease.“Clin Gastroenterol Hepatol. 2006 Feb;4:196-202.
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.
Bergenstock M, McKee J, Johal A.NSAID-Induced Colitis Masquerading as Fistulizing Crohn’s Disease: 1484.American Journal of Gastroenterology.2018;113:(S852).Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514.Ahluwalia A, Hoa N, Jones MK, Tarnawski AS.NSAID-induced injury of gastric epithelial cells is reversible: roles of mitochondria, AMP kinase, NGF, and PGE2.Am J Physiol Gastrointest Liver Physiol. 2019;317(6):G862-G871.Hijos-Mallada G, Sostres C, Gomollón F.NSAIDs, gastrointestinal toxicity and inflammatory bowel disease.Gastroenterol Hepatol. 2022;45(3):215-222.Chen Y, Chen L, Xing C, et al.The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis.BMC Gastroenterology. 2020;20:192.Rudwaleit M, Baeten D.Ankylosing spondylitis and bowel disease.Best Pract Res Clin Rheumatol. 2006;20(3):451-471.UpToDate.Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics).Baillie S, Norton C, Saxena S, Pollok R.Chronic abdominal pain in inflammatory bowel disease: a practical guide.Frontline Gastroenterology. 2024;15(2):144-153.
Bergenstock M, McKee J, Johal A.NSAID-Induced Colitis Masquerading as Fistulizing Crohn’s Disease: 1484.American Journal of Gastroenterology.2018;113:(S852).
Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A.Mechanisms of damage to the gastrointestinal tract from nonsteroidal anti-inflammatory drugs.Gastroenterology. 2018;154(3):500-514.
Ahluwalia A, Hoa N, Jones MK, Tarnawski AS.NSAID-induced injury of gastric epithelial cells is reversible: roles of mitochondria, AMP kinase, NGF, and PGE2.Am J Physiol Gastrointest Liver Physiol. 2019;317(6):G862-G871.
Hijos-Mallada G, Sostres C, Gomollón F.NSAIDs, gastrointestinal toxicity and inflammatory bowel disease.Gastroenterol Hepatol. 2022;45(3):215-222.
Chen Y, Chen L, Xing C, et al.The risk of rheumatoid arthritis among patients with inflammatory bowel disease: a systematic review and meta-analysis.BMC Gastroenterology. 2020;20:192.
Rudwaleit M, Baeten D.Ankylosing spondylitis and bowel disease.Best Pract Res Clin Rheumatol. 2006;20(3):451-471.
UpToDate.Patient education: Sulfasalazine and the 5-aminosalicylates (Beyond the Basics).
Baillie S, Norton C, Saxena S, Pollok R.Chronic abdominal pain in inflammatory bowel disease: a practical guide.Frontline Gastroenterology. 2024;15(2):144-153.
Kefalakes H, Stylianides TJ, Amanakis G, Kolios G.Exacerbation of Inflammatory Bowel Diseases Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs: Myth or Reality?.Eur J Clin Pharmacol. 2009;65(10):963-70. doi: 10.1007/s00228-009-0719-3.Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS.Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.J Clin Gastroenterol. 2016;50(2):152-6. doi: 10.1097/MCG.0000000000000421.Mahadevan U, Loftus EV, Tremaine WJ, Sandborn WJ.Safety of Selective Cyclooxygenase-2 Inhibitors in Inflammatory Bowel Disease.Am J Gastroenterol. 2002;97(4):910-4. doi:10.1111/j.1572-0241.2002.05608.x.Matuk R, Crawford J, Abreu MT, Targan SR, Vasiliauskas EA, Papadakis KA.The Spectrum of Gastrointestinal Toxicity and Effect on Disease Activity of Selective Cyclooxygenase-2 Inhibitors in Patients With Inflammatory Bowel Disease.Inflamm Bowel Dis. 2004;10(4):352-6.https://doi.org/10.1097/00054725-200407000-00005.Ribaldone DG, Fagoonee S, Astegiano M, et al.Coxib’s Safety in Patients With Inflammatory Bowel Diseases: A Meta-Analysis.Pain Physician. 2015;18(6):599-607.Sandborn WJ, Stenson WF, Brynskov J, et al.Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study.Clin Gastroenterol Hepatol2006 Feb;4: 203-2011.Singh S, Graff LA, Bernstein CN.Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?Am J Gastroenterol2009; 104:1298–1313.Takeuchi K, Smale S, Premchand P, et al. “Prevalence and Mechanism of Nonsteroidal Anti-inflammatory Drug-Induced Clinical Relapse in Patients with Inflammatory Bowel Disease.“Clin Gastroenterol Hepatol. 2006 Feb;4:196-202.
Kefalakes H, Stylianides TJ, Amanakis G, Kolios G.Exacerbation of Inflammatory Bowel Diseases Associated With the Use of Nonsteroidal Anti-Inflammatory Drugs: Myth or Reality?.Eur J Clin Pharmacol. 2009;65(10):963-70. doi: 10.1007/s00228-009-0719-3.
Long MD, Kappelman MD, Martin CF, Chen W, Anton K, Sandler RS.Role of Nonsteroidal Anti-Inflammatory Drugs in Exacerbations of Inflammatory Bowel Disease.J Clin Gastroenterol. 2016;50(2):152-6. doi: 10.1097/MCG.0000000000000421.
Mahadevan U, Loftus EV, Tremaine WJ, Sandborn WJ.Safety of Selective Cyclooxygenase-2 Inhibitors in Inflammatory Bowel Disease.Am J Gastroenterol. 2002;97(4):910-4. doi:10.1111/j.1572-0241.2002.05608.x.
Matuk R, Crawford J, Abreu MT, Targan SR, Vasiliauskas EA, Papadakis KA.The Spectrum of Gastrointestinal Toxicity and Effect on Disease Activity of Selective Cyclooxygenase-2 Inhibitors in Patients With Inflammatory Bowel Disease.Inflamm Bowel Dis. 2004;10(4):352-6.https://doi.org/10.1097/00054725-200407000-00005.
Ribaldone DG, Fagoonee S, Astegiano M, et al.Coxib’s Safety in Patients With Inflammatory Bowel Diseases: A Meta-Analysis.Pain Physician. 2015;18(6):599-607.
Sandborn WJ, Stenson WF, Brynskov J, et al.Safety of Celecoxib in Patients With Ulcerative Colitis in Remission: A Randomized, Placebo-Controlled, Pilot Study.Clin Gastroenterol Hepatol2006 Feb;4: 203-2011.
Singh S, Graff LA, Bernstein CN.Do NSAIDs, Antibiotics, Infections, or Stress Trigger Flares in IBD?Am J Gastroenterol2009; 104:1298–1313.
Takeuchi K, Smale S, Premchand P, et al. “Prevalence and Mechanism of Nonsteroidal Anti-inflammatory Drug-Induced Clinical Relapse in Patients with Inflammatory Bowel Disease.“Clin Gastroenterol Hepatol. 2006 Feb;4:196-202.
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