Anti-inflammatory Painkillers

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What are anti-inflammatory painkillers?

Anti-inflammatory painkillers are sometimes called non-steroidal anti-inflammatory drugs (NSAIDs), or just 'anti-inflammatories'. There are over 20 types. They include: aceclofenac, acemetacin, aspirin (see also below), celecoxib, dexibuprofen, dexketoprofen, diclofenac, diflunisal, etodolac, etoricoxib, fenbrufen, fenoprofen, flurbiprofen, ibuprofen, indomethacin, lumiracoxib, ketoprofen, mefanamic acid, meloxicam, nabumetone, naproxen, piroxicam, sulindac, tenoxicam, and tiaprofenic acid. Each of these also come as different brand names.

Anti-inflammatories are used to ease pain in various conditions including: arthritis (various types), muscle and ligament pains (strains and sprains), period pain, pains after operations, headaches, migraines, and some other types of pain. You need a prescription to get anti-inflammatories, apart from ibuprofen and aspirin which you can also buy from pharmacies.

Ibuprofen and aspirin are also used to bring down a high temperature. Low dose aspirin is also used to help prevent blood clots that can cause a heart attack or stroke. (See separate leaflet called 'Aspirin to Prevent Blood Clots'.)

How do anti-inflammatory painkillers work?

They work mainly by reducing the amount of prostaglandins that are made. Prostaglandins are chemicals that are released by cells at sites of injury. Prostaglandins are involved in causing inflammation and swelling. They also sensitise nerve endings which can cause pain. Anti-inflammatories stop certain enzymes (chemicals) from working that are needed to make prostaglandins. Therefore, as you make less prostaglandins, you have less inflammation and pain.

How effective are anti-inflammatory painkillers?

After a single dose, they work at least as well as paracetamol to ease pain, and they may even be better. With repeated doses, they also reduce inflammation. This may further reduce pain and stiffness that occurs with inflammatory conditions such as arthritis and muscle sprains. So, you might not notice the maximum effect for up to 1-3 weeks after starting a course of tablets.

Some general points about taking anti-inflammatory painkillers

It is often worth trying paracetamol before taking an anti-inflammatory. Paracetamol is a good painkiller, and is less likely to cause side-effects. Although paracetamol does not reduce inflammation, it is often the preferred painkiller for muscle and joint conditions that cause pain but have little inflammation. For example, osteoarthritis.

Anti-inflammatories do not alter the course of painful conditions such as arthritis. They just ease symptoms of pain and stiffness. However, this may provide further benefit because, if pain is eased, you may then be able to move around more easily or use a painful joint more easily. The inflammation and pain of various types of arthritis often 'comes and goes'. During good spells, when symptoms are not too bad, you may not need to take anti-inflammatories.

The different types of anti-inflammatories have pros and cons which is why different people take different ones. For example:

• Some are less likely to cause side-effects, but may not be as strong as others.
• Some need to be taken more often each day than others.

Some people find that one preparation works better than another for them. If one preparation does not work very well at first, then a different one may work better. It is not unusual to try two or more preparations before finding one that suits you best. Your doctor can advise.

What are the possible side-effects and risks?

Most people who take anti-inflammatories have no side-effects, or only minor ones. Read the leaflet that comes with the tablets for a full list of cautions and possible side-effects. One important caution is that, ideally, you should not take anti-inflammatories if you are pregnant. The following highlight some of the more important side-effects to be aware of.

Bleeding into the stomach and gut
Anti-inflammatories sometimes cause the lining of the stomach to bleed. Sometimes a stomach ulcer develops. Sometimes bleeding is severe, and even life-threatening. Elderly people are more prone to this problem, but it can occur in anybody. Therefore, if you are taking an anti-inflammatory and you develop upper abdominal pains, pass blood or black stools, or vomit blood, then stop taking the tablets and see a doctor as soon as possible, or go to a casualty department.

The risk of bleeding into the stomach is increased if you are taking an anti-inflammatory plus warfarin, steroids, or low-dose aspirin (used by many people to help prevent a heart attack or stroke). These combinations of drugs should only be used if absolutely necessary.

Some people need an anti-inflammatory to ease pain, and yet are at increased risk of stomach bleeding. For example, people over 65, or those with a past history of a stomach or duodenal ulcer. In such cases another drug may also be prescribed to protect the lining of the stomach from the effects of the anti-inflammatory. This usually prevents bleeding and ulcers from developing if you take an anti-inflammatory. Another option sometimes considered is to take an anti-inflammatory that some studies suggest may possibly have a lower risk of causing stomach bleeding. These type of anti-inflammatories are called selective cox-2 inhibitors and include celecoxib, etoricoxib, and lumiracoxib. However, you should not take a selective cox-2 inhibitor if you have ischaemic heart disease (angina, heart attack, heart failure, etc) or cerebrovascular disease (stroke).

If you have asthma, high blood pressure, heart failure or kidney failure
In some people with asthma, symptoms such as wheeze or breathlessness are made worse by anti-inflammatories. Seek medical help if your asthma suddenly becomes worse after taking an anti-inflammatory. Also, anti-inflammatories can sometimes make high blood pressure, heart failure, or kidney failure worse. If you have any of these conditions, you may be more closely monitored if you are prescribed an anti-inflammatory.

Some other side-effects that sometimes occur include:
Nausea (feeling sick), diarrhoea, rashes, headache, dizziness, nervousness, depression, drowsiness, insomnia (poor sleep), vertigo (dizziness), and tinnitus (noises in the ear). If one or more of these occur they will usually ease off if you stop taking the tablets. There are also a number of other uncommon side-effects - see the leaflet in the tablet packet for details.

© EMIS and PIP 2006   Updated: May 2006   PRODIGY Validated

The authors and editors of this article are employed to create accurate and up to date content reflecting reliable research evidence, guidance and best clinical practice. They are free from any commercial conflicts of interest. Find out more about updating.

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