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Consumer Reports: Overuse of pain relievers can be hazardous

Aspirin, ibuprofen, naproxen and other nonsteroidal anti-inflammatory drugs, or NSAIDs, are good at fighting fevers and relieving pain from arthritis, injuries and other causes. But many people who take the drugs are putting themselves at risk by taking too much or taking them too long or too often. In a 2005 study, one in four people who used over-the-counter pain relievers every day routinely took more than the recommended dose. That’s risky, since even nonprescription NSAIDS can cause serious side effects, including kidney problems or stomach ulcers and bleeding. Here are answers to some basic questions about anti-inflammatory drugs.

How do NSAIDs work?

They fight pain by targeting one or both of two enzymes: COX-1 and COX-2. These enzymes are crucial for the production of hormones called prostaglandins, which trigger inflammation, which in turn sends pain signals to the brain. At high enough doses, NSAIDs can inhibit inflammation and thus thwart pain.

But blocking COX-1 also leaves the stomach vulnerable to ulcers and bleeding, since prostaglandins help protect the lining of the stomach from acid. In fact, 5 to 10 percent of NSAID users experience ulcers or bleeding in a given year.

Prescription or OTC?

If you need an NSAID only occasionally — say, for headaches or mild and intermittent arthritis — you can probably safely get the relief you need from over-the-counter aspirin, ibuprofen or naproxen (Aleve and its generic cousins). But persistent or daily use boosts the risk of complications. That’s why labels on nonprescription NSAIDS warn against exceeding the recommended dose or using them for longer than 10 days without a doctor’s guidance.

If you find that you need to take a nonprescription NSAID several times a week to cope with chronic pain, stiffness or injuries, consult a doctor about strategies to manage the pain effectively and possibly with less medication.

If you have osteoarthritis or another condition that requires the ongoing use of pain relievers, you’re probably better off asking your doctor about taking prescription-strength ibuprofen or naproxen or another prescription NSAID.

Do side effects differ?

Some experts think that naproxen might pose less risk of a heart attack or stroke than other NSAIDs. But there’s not yet enough evidence to determine whether some NSAIDs are really safer for the heart than others. Some studies have found that they can blunt the heart-protective effects of aspirin. So if you take low-dose aspirin for heart or stroke prevention, you should try acetaminophen (Tylenol and its generic cousins) first for pain relief.

Factors that increase the risk of stomach problems include being older than 60, taking daily aspirin for heart-attack prevention and having a history of ulcers or gastrointestinal bleeding. If you fall into one of those groups, talk with your doctor about trying acetaminophen instead of taking a generic NSAID, such as naproxen, with a stomach-acid-reducing drug such as omeprazole (Prilosec OTC and its generic twins).

Which should I try first?

There is no evidence that any NSAID relieves pain more effectively than others at equivalent doses. But some people get more relief from one NSAID than another, so if one doesn’t work for you, try another one.

Based on cost and effectiveness, Consumer Reports Health Best Buy Drugs recommends that people who need a prescription NSAID start with either generic ibuprofen or generic naproxen. They can cost as little as $4 for a month’s supply at chain stores such Target and Wal-Mart, and possibly even less per month if you get a 90-day supply.

With any NSAID, take the lowest dose that brings relief, don’t exceed recommended doses (especially if you take it regularly), and don’t take it for long periods without consulting a doctor. Stay alert for signs of a stomach ulcer: burning stomach pain and bloody, black or tarry stools. Tell your doctor and pharmacist about other medication or supplements you take, since NSAIDs can interact with other treatments.

Copyright 2011. Consumers Union
of United States Inc

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