A journey with chronic back pain is usually accompanied by anti inflammatory medications like NSAIDs (nonsteroidal anti inflammatory drugs). While they do provide temporary pain and inflammation relief, if you’ve been taking NSAIDs for back pain for an extended period of time, it may be time to re-evaluate your pain management plan.
NSAIDs can be helpful for occasional relief from various types of pain and inflammation. They work by blocking a protein in the body called COX enzymes. By blocking this enzyme, your body produces a reduced amount of prostaglandins, a chemical that’s formed in your body tissue at the site of damage or infection. Less prostaglandins equals less pain from inflammation.
But for people living with chronic back pain – pain lasting longer than 12 weeks – it’s a good idea to be aware of the increased risks associated with consistent use of NSAIDs, as they can be quite serious.
Popular names for over-the-counter pain medication include:
Prescription NSAIDs include:
Why NSAIDS can be dangerous
For many people living with chronic back pain (and neck pain), they find themselves taking NSAIDs around-the-clock to ease symptoms. Unfortunately, there’s a misconception that just because OTC, non-steroidal, anti inflammatory drugs like NSAIDs available over the counter, they’re harmless. The truth is that there are risks associated with all medications whether they require a prescription or not.
- heart attack
- high blood pressure
- heart failure from body swelling (fluid retention)
- kidney problems including kidney failure
- bleeding and ulcers in the stomach and intestine
- low red blood cells (anemia)
- life-threatening skin reactions
- life-threatening allergic reactions
- liver problems including liver failure
- asthma attacks in people who have asthma
- stomach pain
The smart approach to NSAIDs
Another way NSAIDs can be potentially dangerous is that some patients may not realize they’re taking too much. This can happen for a few different reasons. They may ignore the recommended dosage of the pain reliever, assuming it’s okay to take more. In their quest for relief, they throw caution to the wind and pop pills until they feel better.
A study of 1,300 people taking ibuprofen revealed that 15% took more than the recommended dosage. It also noted that exceeding the recommended maximum dose was “especially common among men, those with chronic pain, those with poor knowledge of dosing recommendations, and those who believed in choosing my own dose.”
Some back pain patients follow dosage instructions, but they don’t realize other medications they’re taking like OTC cold and flu medication contain NSAIDs too, so they’re taking too much. Plus, there are prescription medications that can trigger dangerous, adverse reactions when mixed with NSAIDs.
If you’ve been diagnosed with a back condition and NSAIDs are part of your pain management plan, make sure you’ve discussed your dosage with your healthcare team, including your pharmacist. Self-medicating without proper guidance is risky.
FDA strengthens warning labels
In February 2018, the Food and Drug Association (FDA) strengthened its warning that non-steroidal, anti-inflammatory drugs can cause heart attacks or strokes. Their research indicates that “the risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.” The risk is also greater at higher doses.
Furthermore, NSAIDs can increase your risk of heart attack or stroke even if you don’t have heart disease. FDA studies found that “patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.”
Also, patients who suffered a heart attack and were treated with NSAIDs were more likely to die in the first year after the heart compared to heart attack patients who were not treated with NSAIDs.
Other studies suggest NSAIDs have been linked to increased risk for kidney, bone and hearing problems.
What to know if you’re taking NSAIDs
If you’re following a pain treatment plans for acute back pain, it is safe to take NSAIDs as directed with certain medications like muscle relaxants. Clinical trials have shown a combination of the two work well for pain relief.
When it comes to taking NSAIDs for chronic back pain, use the lowest effective amount for the shortest possible time. If you take a low-dose aspirin as part of your preventative care against heart attack or stroke, speak with your doctor because some NSAIDs can interfere.
Seek medical attention immediately if you experience symptoms such as:
- Chest pain
- Shortness of breath or trouble breathing
- Sudden weakness or numbness in one part or side of the body
- Sudden slurred speech
Achieving pain relief without NSAIDs
Taking NSAIDs may be a temporary solution, but eventually you’ll need to transition to a pain management plan that doesn’t include relying on NSAIDs for back pain. That may be a scary thought at the moment, but in the long run, physical therapy and proper self care is the best route for your long-term health and recovery.
If you’re currently taking NSAIDs for back pain, work with your healthcare team to devise a plan that includes weaning yourself off of them. Most healthcare professionals agree taking NSAIDs is not a safe long-term treatment for pain relief.
A combination of healthy lifestyle choices that include mindful, low-impact exercise like walking, swimming, yoga or Tai Chi can help you build the muscles you need to better support your spine and take pressure off of your discs.
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This post was updated in January 2019 with new information and resources.