Had a rough day on the slopes? Maybe you pushed a little too hard at the gym? Or, you woke up with a crick in your neck. The first thing you might do is pop an ibuprofen or naproxen.
At first, it may seem like this is practice, but these quick fixes can have long-term impacts on your health.
What is an NSAID?
You’ve probably heard the term “NSAID” (pronounced EN-SED) thrown around on TV, by doctors, or even your peers.
So what does it mean?
NSAID is an acronym for nonsteroidal anti-inflammatory drug. They’re a class of drugs that reduce inflammation (and the pain caused by this inflammation).
These drugs work through a complex process that suppresses a certain enzyme known as cyclooxygenase (COX). COX is responsible for the inflammation that can make your joints achy, stiff or sore.
How does this happen? COX enzymes stimulate the production of prostaglandins. Prostaglandins lead to an increase in the blood flow to an area and trigger chemotaxis.
Chemotaxis signals white blood cells to migrate to an area, thus increasing fluid buildup.
Both COX-1 and COX-2 are the most prominent cyclooxygenases present when looking at pain and inflammation.
So NSAIDs take care of this pain? Sounds great, right?
In theory, they’re brilliant. They are used extensively for those that suffer from debilitating conditions such as rheumatoid arthritis.
Why is all of this important? Don’t they say not to look a gift horse in the mouth?
Well, we’re telling you – go ahead, open his mouth and look straight down that horse’s throat. These drugs are being touted as a safe, everyday option for releasing you of your aches and pains, but they have a side most people don’t see.
How NSAIDs Work
It seems almost magical – you have a screaming headache. Down a couple of ibuprofen and BAM! Twenty minutes later the throbbing is gone.
The effectiveness of NSAIDs can’t be denied – this is what has pushed drug researchers and manufacturers to find the newest and best formulas.
Just how they work is really pretty complex; there is a series of chemical reactions and other processes that take place.
Your body has all sorts of enzymes in it. They do everything from help digest your food to regulate your blood sugar and all other kinds of functions.
NSAIDs are specifically formulated to block the COX enzymes.
When used, NSAIDs help arrest the production of the prostaglandins, reducing the ability for the body to respond with pain, swelling and fever.
Is Newer Really Better?
There are numerous NSAIDS available on the market today. One of these has been around for thousands of years.
Aspirin, also known as acetylsalicylic acid, was originally derived from willow bark.
While aspirin can be really hard on your stomach, this natural NSAID doesn’t carry with it the multitude of problems that go hand-in-hand with modern NSAIDs. It’s also the only one that can be used to actually help prevent heart attack.
Ibuprofen, naproxen, celecoxib, and diclofenac sodium have all been developed in the hopes of bringing relief; there have also been many one-hit wonders that, like those iconic tunes, have enjoyed a short burst of fame before being removed from the market for numerous reasons, including side effects.
When it comes to treating pain and other issues, maybe Mother Nature really does know best.
The economics of the NSAID game
NSAIDs make up the majority of over-the-counter and prescription pain medications that are used and prescribed in the US.
The number of prescriptions written for these drugs each year in the US alone exceeds 70 million, with upwards of 30 billion doses of these drugs being taken annually.
If all those inch-long caplets were laid end-to-end, they would literally reach to the moon and back. That’s a lot of pills!
Advil® (brand name for ibuprofen), for instance, is the leading trade name painkiller with sales in the US soaring to $484 million in 2017. Aleve® and Tylenol® run closely behind in second and third place.
In 2017, $4.2 billion was spent on internal analgesics – this includes the old standby drugs such as aspirin and acetaminophen.
What does this tell us?
As a nation we’re in a lot of pain. Not only that, but we’re merely masking the symptoms with temporary relief in the form of NSAIDS, rather than trying to address the causes.
It’s estimated that 30 million people take NSAIDs on a daily basis.
This long-term use is eating away at their bodies (particularly their stomachs) and not actually addressing the root causes of the pain. Does it really make sense to take a drug that isn’t healing but rather just hiding the evidence of a larger problem?
That Pain in Your Gut May Be Trying to Telling You Something
Has your doctor ever told you to take an ibuprofen, but recommended that you eat something before doing so?
There is a good reason for that – ibuprofen and many other NSAIDs can have some pretty damaging effects on the stomach and rest of the GI system.
COX-1 and COX-2 help control many body functions, but COX-2 actually helps to protect the stomach. When it is blocked by NSAIDs, its ability to prevent damage is minimized.
What are some of the ways that NSAIDs wreak havoc? Here are a few:
- Irritation of the epithelium (stomach lining)
- Reduction in effectiveness of the mucosal barrier (the highly specialized and protective layer inside your stomach and intestines that helps keep the bad stuff such as toxins, digestive acids and bacteria from entering your bloodstream, while still allowing nutrients to pass through)
- Decreased gastric mucosal blood flow
- Difficulty repairing superficial injuries
- Suppression of the gastric prostaglandin production
All of these issues can begin to wear away at the different layers of your stomach, resulting in an ulcer that can be quite painful and even start bleeding.
The presence of food with NSAIDs can help provide a basic buffer but isn’t enough to completely protect your stomach. The ongoing exposure from these drugs having to pass through the digestive system can take its toll.
Plus, think about this: if, for example, your elbow hurts, doesn’t it make more sense to go directly to the source of the pain, rather than expecting the body to carry the burden of digesting and metabolizing a tablet? This is where transdermals can become your new best friend.
Do NSAIDs Cause Strokes and Heart Attacks?
In the early 2000’s there was a lot of buzz about an NSAID known as Vioxx®.
This drug was linked to more than 140,000 heart attacks in five years – the amount of time it was on the market. In 2004 it was discontinued, due to this tragic side effect.
In 2005 the FDA cracked down on NSAID producers and required they change their labeling to include more accurate warnings.
Ten years later, in 2015, they made an even more adamant statement, trying to drive home the potentially fatal side effects of these drugs.
The chemical and physiological processes by which COX-2 inhibitors can cause heart attacks and strokes is very complex. When broken down into simpler terms, COX-2 inhibitors remove the body’s ability to prevent blood clots and can actually encourage the formation of them.
Blood clots lead to both heart attack and strokes by causing blockages in blood vessels, preventing blood from flowing freely.
Interestingly, aspirin is used to help prevent strokes and heart attacks. It is the only NSAID that is safe for this purpose. It helps prevent clotting, which is why you will often be advised to avoid it before dental procedures or other surgeries.
With the wide variety of effective, safer pain remedies, taking NSAIDS seems like a game of Russian roulette.
NSAIDs Deliver a Nasty Kidney Punch
Another downside to NSAID use is the effect it can have on your kidneys.
While occasional use in someone with healthy kidneys usually doesn’t pose any problems, if you have any sort of kidney disease or renal insufficiency, NSAIDs can cause serious damage.
This is because your kidneys depend on those chemicals we mentioned before – prostaglandins.
When the synthesis of prostaglandins is inhibited, your kidneys have to work extra hard to try and function. Prostaglandins help increase blood flow, allowing better filtration of toxins and the subsequent excretion through your urine.
If this process is disrupted, the potential for a build-up of toxins in your kidneys (and the body, at large), is increased. This can lead to everything from infections and illness to full-blown organ failure.
The Other Side Effects of NSAIDs
As if the potentially negative side effects on your stomach, heart, lungs, brain and kidneys aren’t enough, there are dozens of other side effects that can come with NSAID use.
In addition to heart attacks, heart failure is a possibility. This is because NSAIDs can increase fluid retention and put undue stress on your heart. This is an indirect result of kidney function being compromised.
Hopefully, you’re not one of them, but some people also experience skin reactions or allergic reactions that can vary from mildly annoying to life-threatening. This is because your body might view the NSAID as a threat and your immune system erroneously attacks it.
Asthma has also been noted with the use of NSAIDs; again, this is likely the body’s reaction to a substance it is unable to readily identify.
On a lesser scale, NSAIDs have been reported to cause non-ulcer stomach pain, nausea, heartburn, dizziness, vomiting, constipation, diarrhea and gas. Sounds like a regular party, doesn’t it?
Seeking Safer Pain Relief
Yes, it might be super convenient to pop that pill a couple of times a day, but at what cost to your health?
If you are regularly using NSAIDs, you may want to consider cutting back the amount you are taking (for instance, only taking it when you absolutely need it), or replacing your NSAIDs with safer alternatives.
Nature definitely has a trick or two up her sleeve when it comes to effective relief from pain and inflammation.
That savory, pungent golden spice that kicks your curries up a notch is turmeric. Aside from lending a unique flavor to foods, turmeric contains curcumin, a highly effective anti-inflammatory and analgesic.
Used for thousands of years, this herb is now being carefully processed and standardized, so you can reap the maximum rewards.
Not only is turmeric useful when taken internally, but it can kick some serious pain right in the butt when used topically.
Other herbs and spices that have proven to be worth their weight in gold in the medicine cabinet are ginger, black pepper and boswellia. All of these, whether taken internally or used in transdermal form can provide some serious relief from pain and swelling.
Moving in the Right Direction
Strangely enough, exercise can actually help decrease pain and swelling. This is because it increases blood flow, allowing the toxins that increase discomfort to be carried away more readily.
Exercise also increases flexibility and prevents muscles and tendons from becoming stiff and inflexible.
Yoga, swimming, and other gentle forms of exercise are very helpful in keeping joints in top condition without putting any unneeded stress on them.
Food as Medicine
As with nearly everything health-related, diet plays a huge part in your overall well-being, including your energy levels and whether or not you’re experiencing pain.
Sugar can be a major culprit. It’s also one of the hardest to avoid – sugar is added to almost every processed food available in grocery stores.
Cutting back or eliminating refined sugars can make a huge difference in how you feel and even look.
A good rule of thumb is to eat things that are as close to their natural form as possible. The less processed it is, the less likely you are to consume things that aren’t so great for you.
Sleeping the Pain Away
If you don’t get enough sleep, you may be setting yourself up for a day of aches and pains.
It seems like the two shouldn’t be connected, but they are – almost to the point of being inseparable.
When your body and mind are tired or fatigued they can trigger the release of cortisol. Cortisol is a stress hormone that has a very important role in supporting your body in times of stress.
Unfortunately, your body doesn’t know the difference between true stress and just being tired, so chronic lack of sleep keeps cortisol pumping into your system.
Cortisol excess can take its toll on you in many ways; it can prevent your body from properly fighting infection (it suppresses the immune system), it often promotes inflammation, and can even affect your digestion.
This is a whole other topic we’ve covered here, but the bottom line? Get enough sleep every night. Not sure how much that is? Check out the National Sleep Foundation’s chart for guidelines on how much sleep you should be getting.
If you are relying on NSAIDs to alleviate your pain, you may want to take a step back and assess your use. These drugs can have some side effects that may leave you in a much different world of hurt with extended use.