Important Facts About Non-Narcotic Pain Drugs

A third of Americans over 65 use nonsteroidal anti-inflammatory drugs (NSAIDs) every day, according to the American Pain Foundation. For the chronic pain patient, it's critical to understand the most basic drugs in your war on pain.

Most painkillers (or analgesics, from the Greek term for the absence of pain) work on the central nervous system—the brain and the spinal cord—and the peripheral nervous system, which connects the rest of the body to them, sending signals back and forth.

Painkillers are generally broken down into three categories: opioid (narcotic) analgesics, non-narcotic analgesics (which include NSAIDs), and adjuvant therapies such as anticonvulsants, muscle relaxants, and antidepressants. We'll deal with NSAIDs here.

How NSAIDs work
The granddaddy of NSAIDs is aspirin (acetylsalicylic acid), made from a compound found in willow bark and introduced into modern medicine in 1899. Ibuprofen, a non-aspirin analgesic, was introduced in 1974 and is best known as Advil or Motrin. Naproxen was first marketed in 1976, and is best known as Aleve.

Taken with care, NSAIDs are a staple of the pain patient's medicine cabinet.
Most NSAIDs work by blocking two enzymes, COX-1 and COX-2, which help produce substances that are the real villains in the pain picture, prostaglandins—hormone-like substances that perform a variety of regulatory jobs in the body.

Prostaglandins are created at the sites of injury or inflammation and cause the pain receptors in the surrounding area to become more sensitive. By decreasing prostaglandin production, NSAIDs lessen the sensation of pain and reduce inflammation.

The problem is that the COX-1 enzyme has an important job to do: It helps produce the prostaglandins that protect the stomach lining from the corrosive effects of stomach acid. When COX-1 is blocked, stomach upset, bleeding, and ulcers can occur. These are well-known side effects of all NSAIDs.

Individuals react differently to dosage, but in general, taking more than the daily recommended amount of an NSAID carries a significant risk of gastrointestinal bleeding and is unlikely to provide additional pain relief. (Parents should consult a physician before giving aspirin to a child or adolescent. When used to treat a viral infection, such as the flu or chicken pox, aspirin and other medications containing salicylates have been linked to an increased risk of developing Reye's syndrome, a potentially life-threatening illness.)

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Last Updated: April 06, 2008

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