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Nonsteroidal anti-inflammatory drugs, most commonly referred to as NSAIDs, are a class of medications that include many popular over-the-counter and prescription pain relievers and fever reducers. These drugs produce their positive effects by inhibiting the function of cyclooxygenase, an enzyme vital to the production of prostaglandins and thromboxane. These lipid compounds play a critical role in transmitting pain signals and inflammation messages. By suppressing their formation in the bloodstream, NSAIDs reduce the pain and inflammation produced within the body.

Categories of NSAIDs

The two most common types of NSAIDs are salicylates and derivatives of propionic acid.

  • Salicylates include aspirin, one of the most common medications. Aspirin is generally available without a prescription.
  • Propionic acid derivatives include ibuprofen, naproxen, ketoprofen and loxoprofen; ibuprofen and naproxen medications are available in over-the-counter formulations.

These medications provide significant relief from pain, especially back pain caused or worsened by inflammation and pressure on the spinal column. Other categories of NSAIDs include the following:

  • Fenamic acid derivatives, including flufenamic acid and tolfenamic acid
  • Selective cyclooxygenase-2 inhibitors
  • Sulphonanilides
  • Derivatives of acetic acid, including indomethacin and ketorolac
  • Enolic acid derivatives
  • Licofelone

St. John’s wort and figwort contain significant amounts of NSAID compounds and are sometimes used to treat pain and inflammation.

Uses for NSAIDs

NSAIDs are generally regarded as a first line of defense against chronic and severe pain. They can also be used to reduce fever and inflammation. Common uses for NSAID compounds include the following ailments:

  • Headache
  • Severe or chronic backache or spinal pain
  • Rheumatoid arthritis and osteoarthritis
  • Anklyosing spondylosis
  • Sprains
  • Menstrual pain
  • Neuropathic pain
  • Gout

Because NSAIDs reduce pain and inflammation at the same time, they are ideally suited for use in treating back pain caused by strained muscles, misaligned vertebrae and other spinal disorders. Unlike other NSAIDs, aspirin also serves as a blood thinner and is frequently prescribed in low doses to individuals at risk for stroke or heart disease.

Contraindications for NSAIDs

Patients with sensitivities to any of the NSAID category medications should avoid these drugs. Additionally, patients with asthma or a history of serious skin reactions and allergies should avoid NSAID use as these medications can provoke or worsen these reactions in susceptible patients.

Known Drug Interactions

NSAIDs can interact with a wide range of other drugs to include other NSAID medications. As a result, patients should inform their physician if they are currently taking any of the following prescription and nonprescription medications:

  • Aspirin
  • Ibuprofen
  • Naproxen
  • Diuretics
  • Lithium
  • Phenytoin
  • Warfarin
  • Clozapine
  • Quinolone

These medications can interfere with or amplify the effects of the NSAID and cause mild to serious complications for patients.

Side Effects of NSAIDs

While the NSAID category of pain relievers is remarkably safe, side effects can occur even with these commonly used medications. Gastrointestinal complications are the most commonly experienced side effects and range from minor dyspepsia to obstructions, bleeding and ulcers. Serious side effects include the following:

  • Cardiovascular complications
  • Renal damage or failure
  • Hypertension
  • Stroke
  • Liver damage or failure

Patients who exhibit any of the symptoms of these side effects should immediately contact a physician and seek medical attention as these complications can be life threatening if not treated promptly.

Used properly, NSAIDs are among the most effective and useful medications for patients with chronic and severe back pain conditions. NSAIDs should be used under the supervision of a physician to ensure patient safety and provide effective relief for pain and inflammation.