The Best Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for treating a variety of common conditions, like arthritis, tendonitis, and bursitis. NSAIDs are useful because they help decrease pain, control swelling, and reduce inflammation.

However, anti-inflammatory medicines also come with some side effects, especially for people who have underlying risk factors. This article discusses the pros and cons of prescription and over-the-counter NSAIDs and alternatives to anti-inflammatory drugs.

Prescription vs. OTC NSAIDs

NSAIDs are available in both over-the-counter (OTC) and prescription formulations. Some of the OTC anti-inflammatories are also available in stronger, prescription formulations. A class of NSAIDs called COX-2 inhibitors is available by prescription only.

While both OTC and prescription NSAIDs help relieve pain, prescription NSAIDs are more likely to reduce inflammation.

Many people experience adequate symptom relief with OTC NSAIDs and do not need to take stronger, prescription-strength options. Sometimes prescription NSAIDs are used because they provide longer-lasting relief. COX-2 inhibitors may be an option for people who have gastrointestinal side effects, which are common with OTC NSAIDs.

Which NSAID Is Best?

Usually, different NSAIDs can have similar effects. For example, if you are experiencing discomfort from arthritis, you might get relief from either Aleve (naproxen) or Advil (ibuprofen). But sometimes, people have a different response to treatment with a different medication, and a few medications might help your symptoms, while others do not have a significant effect.

It's difficult to predict which medications will be the most beneficial. The best way to determine which NSAID is best for you is to try different options. Often a healthcare provider will recommend one NSAID, and if symptoms don't improve within several weeks of treatment, another NSAID can be tried.

One of the best reasons to consider some of the COX-2 inhibitors, such as Celebrex or Mobic, is that these may be taken as once-a-day doses rather than three or four times daily. In addition, the COX-2 inhibitors are thought to have fewer side effects on the stomach.

Most Common NSAIDs

Healthcare professionals often use generic and brand names interchangeably, especially when recommending or prescribing NSAIDs.

The most commonly prescribed or recommended NSAID medications are:

• Bayer, Ecotrin, Bufferin (aspirin)
• Motrin, Advil (ibuprofen)
• Aleve, Naprosyn (naproxen)
• Mobic (meloxicam)
• Celebrex (celecoxib)
• Indocin (indomethacin)

Additional Treatment Options for Inflammation

Medicine isn't the only way to control inflammation and discomfort. Due to the possible side effects of medication, many patients and healthcare providers are interested in non-pharmacologic methods to control inflammation, especially chronic inflammation.

There are many ways to manage inflammation. Some have better scientific support than others, but almost all are safe to try.

A good place to start is with the R.I.C.E. treatment, which stands for:

• Rest
• Ice
• Compression
• Elevation

Other treatments that may be helpful include certain foods and supplements, topical treatments, and physical activities.

An often-neglected method to control inflammation is rest. Getting enough overall rest and sleep, as well as taking it easy on the injured part of your body allows the inflammation to subside and the recovery process to unfold.

Not only does this mean resting from athletics, but often this means allowing an injured body part to rest from normal activities that may prolong inflammation. If you have a busy life, rest might not be built into your routine, but ignoring the signs of inflammation may prolong the problem.

Side Effects of NSAIDs

NSAID medications have potential side effects, even those that can be obtained over-the-counter. Some of the side effects are minor, and others are potentially dangerous.

Some people may be more prone to side effects. However, it is important to understand that even for healthy people without underlying medical conditions, there is an associated risk. The benefits of taking an anti-inflammatory medication need to be balanced with the possible risks of taking the medication.

Some of the more common side effects of NSAID medications include:

• Stomach upset/ulcers: Some people are prone to gastrointestinal upset and stomach ulcers as a result of taking these medications. People with a history of stomach ulcers need to use extreme caution with NSAIDs, and always under the supervision of their healthcare provider.
• Hypertension/stroke: The use of NSAID medications, especially for routine, longer-term use, has been shown to increase the risk of hypertension and stroke.
• Bleeding risk: Certain NSAID medications can cause an increased risk of bleeding. This is particularly true for aspirin. Most people can tolerate this, but people who have upcoming surgical procedures or are on other blood-thinning medications may not be able to take NSAID medication and will usually be advised to stop taking them for a specified amount of time prior to having the procedure.
• Kidney problems: People with underlying kidney conditions may not be able to take NSAID medications, even in very low doses for a short time.
• Heart disease: The COX-2 inhibitors have an FDA black box warning regarding an increased risk of heart attack. NSAIDs should not be used in the setting of prior heart disease, especially if you have had a coronary artery bypass graft (CABG).

These are not the only risks associated with NSAIDs, but they are the most common. It is always safest to have a discussion with your healthcare provider if you have any concerns about the risk of taking these medications.

A Word From Verywell

Nonsteroidal anti-inflammatory medications are commonly used for managing symptoms of musculoskeletal conditions. NSAIDs can be effective for a wide variety of conditions like arthritis, tendinitis, or other inflammatory conditions.

Determining the best anti-inflammatory drug for your condition may depend on a number of different factors, and what works well for one individual may not be the best medication for another. There are possible side effects of different NSAID medications you should be aware of, and you should check with your healthcare provider if you're taking these medications for more than a short period of time.