NSAIDs—Are They Worth It?

NSAIDs—Are They Worth It?


Nonsteroidal anti-inflammatory drugs have the potential to relieve/reduce pain, inflammation, and a fever. 

The most prominent examples include aspirin, ibuprofen (Advil, Motrin), diclofenac (Voltaren) and naproxen (Aleve, Naprosyn). 

Sounds good; but, are they?



Aspirin was the first in the category (1899) with the possible exception of an herb called willow bark.

Aspirin begins to act within a half-hour, gets to peak activity in about 1.5 hours, and its duration of activity is 3-6 hours for pain and inflammation.  However, it reduces your ability to clot (stop bleeding) for at least 10 days.

The characteristics of aspirin are somewhat different than the other NSAIDs.  Low dose aspirin is often recommended for heart disease, primarily if one has already had a heart attack due to a blockage or blood clot. 

It is also recommended for men (The study outcomes are different for women.) who are prone to strokes due to a blood clot.  (The results of some studies would lead one to question whether these benefits are true, so this is not a do-it-yourself project.)

Normal doses of aspirin can be used for some forms of arthritis and to reduce inflammation.

Aspirin should not be used in children and teenagers who have chickenpox or the flu lest they develop Reye’s syndrome, which is uncommon but dangerous.

Caution if on blood thinners or are pregnant and do not take any during the last three months of pregnancy.

However, one needs to be aware of the side effects of aspirin, which is very effective at reducing blood clotting and therefore will increase bleeding (if cut) and bruising.  If you are taking aspirin, make sure to tell your doctor if you are scheduled for surgery of any type.

Aspirin can be very hard on the lining of your stomach and may lead to stomach ulcers.

Use with caution if you have ever had or have ulcers, kidney or liver disease, gout, bleeding problems, severe anemia, diabetes, or ringing of the ears. 


IBUPROFEN (Advil, Motrin) and NAPROXEN

Ibuprofen and naproxen are in the same chemical category.  Their actions are similar. 

Differences include:  ibuprofen gets to peak activity in one to two hours versus two to four hours for naproxen; ibuprofen has a half-life of two hours versus about fourteen hours for naproxen. 

In other words, naproxen is effective for a much longer time span.



Diclofenac is in a different chemical category than the above but its indications are largely similar. 

Diclofenac peak onset is about two hours and its half-life is also about two hours. 

It is available in a topical form as well.



Celebrex is a bit different than the above. 

It is known as a COX-2 inhibitor, which produces a slightly different side effect profile than the rest. 

Some doctors find celecoxib to cause less stomach/intestine irritation, although it is a claim the pharmaceutical company is not permitted to make. 

One should not take celecoxib if allergic to sulfonamides. 

It reaches peak activity in three hours and has a half-life of eleven hours (relatively long acting).



So what’s not to like?

NSAIDs tend to have the same side effects as aspirin, although its effect on platelet aggregation (increased bleeding) is less and gastrointestinal side effects may be less. 

The list of potential side effects is long, although the likelihood of many of the side effects tails off rapidly.

Two key concerns are hospitalizations and deaths.  I have searched for accurate numbers regarding both, and it appears to me that accurate numbers do not exist with any high degree of certainty. 

My estimate based upon the studies that I read suggest over 100,000 hospitalizations per year in the United States due to NSAIDs.  As many as 20,000 people may die each year in the U.S. due to NSAIDs. 

That does not mean NSAID use should be eliminated.  It does suggest that if used they should be used in the proper dose, and with caution, especially when such use is chronic.

Perhaps one accepts the above statistics relative to the large number of people taking NSAIDs. 

We then are left with three questions:



Note the use of the word “mask.” 

One could hardly blame a person for wanting to eliminate pain. 

However, I am suggesting that one should work on eliminating the cause of the pain. 

Masking the pain is not always such a good idea. 

For example, if I could mask the pain of a broken foot bone so that you could walk around on the broken bone, would that be to your benefit?



Most of the time, preventing excess inflammation is a good idea. 

However, should we prevent all inflammation? 

Inflammation is generally recognized as the second phase of wound healing. 

If we prevent all inflammation, perhaps we are delaying or even negatively affecting healing.



Mother Nature gave us immune systems to do battle against viruses, bacteria, and other foreign invaders. 

One of the weapons in that battle is a fever.  Most viruses and bacteria are comfortable at normal body temperature.  A  fever (elevated body temperature) helps our immune system to fight those evil organisms. 

True, when we have a fever we may not feel so good, but the fatigue and malaise may be due to the infection itself, and the fever is not harmful unless it gets very high  (over 106 degrees F.). 

If a fever occurs, stay hydrated and try to help your body fight the cause of the infection. 

If you know the cause, such as a cold, and, especially if it is in the evening or your day off, your immune system may be more successful with lots of fluids and less acetaminophen (Tylenol) or NSAIDs.



NSAIDs can reduce pain, inflammation, and fevers, but they come with a price:  side effects. 

Before taking them, it may be best to pause and answer two questions:

1. Do you want to eliminate/reduce/not alter your pain and/or your inflammation and/or your fever?

2. Is the exposure to the side effects a worthwhile trade?

OK, at least they are not steroids, but that is a discussion for another day.




Dr. Goldstein is a podiatrist who is Board certified by the American College of Foot and Ankle Surgeons, the American Board of Podiatric Medicine, and a Fellow of the American Society of Podiatric Surgeons.  He is a member of the American Podiatric Medical Association and the American Society of Podiatric Sports Medicine.  He has run about 33 marathons; if his brain had not bounced up and down so much he could probably remember exactly how many, a problem not usually helped by NSAIDs.


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