It’s happy new year 2022 and like many of us we decided to do some resolutions and get into shape, so we jumped on the bandwagon and joined the local gym and went there worked out on machines we haven’t touched for about 10 years and wake up the next morning and feel pain. Wow or we’re cleaning up the yard or shoveling snow and overdo it, and the next day we feel that pain and that pain is caused by inflammation. What I’d like to do is talk about on this episode some of the anti-inflammatory prescription and nonprescription medications that we use to combat pain or to power through it. So, let’s begin with what is inflammation, what causes it, how does it work in our bodies. What occurs is when our body encounters some type of offending agent, such as a virus or a bacteria, or even a toxic chemical. Or it suffers an injury it could be an injury such as some type of exercise we do motion or movement we do that either causes a rubbing or damaged internally to maybe a joint or tissue. When that happens it activates what we call our immune system. Now our immune system well it’s kind of like the alarm system and when it activates our bodies alarm system that alarm system sends out what we call anti-inflammatory cells, or we can consider them first responders. They then go to that damaged area and activate more first responders’ substances that cause inflammation. Now inflammation many times people think is a bad thing, inflammation is a very good thing and there were two types of inflammation, acute inflammation and chronic inflammation.
Acute inflammation would be due to some type of damage to the body, it could be something externally caused like tripping and you bang your knee, it can be due to over exercise or overstimulation, or over manipulation of body parts, like when you’re shoveling, you’re working out using muscles and joints that have not that have not been doing that for very long time or have been shocked into doing that initially. This can all result in swelling, pain, bruising, and redness that’s what we call inflammation. So, when these cells come to those areas, these inflammatory substances go to that damaged area, and what they do is start to heal those injured tissues. Inflammation also affects other parts of the body that you can’t see, for example the acute inflammation response to sudden body damage like, cutting your finger or getting a splinter these inflammatory substances begin the healing process.
Chronic inflammation this is where the body continually seems to be getting inflamed in that area, an example of this is rheumatoid arthritis where in the joints of the fingers the toes there is a chronic inflammatory or inflammation in those areas. Asthma is many times considered a chronic inflammation of the lung and respiratory areas. Chronic Inflammation can cause constant pain and actual deformities.
So, to recap, inflammation is a response of the body to some type of irritant, it could be a pathogen such as bacteria or viruses, could be an external injury such as scrapes cuts foreign bodies entering our body. It can be caused by over stimulation or over manipulation, such as using muscle parts and joints, that have not been used in a very long time or not been used to that measure or that extreme. It can be caused by chemicals. So, inflammation has several different ways that it stimulates the body’s immune system which is kind of like the alarm system and sends out substances that act like first responders and go to that specific area that’s been damaged or irritated. The immune system starts the healing process, and you’ll notice that inflamed areas they turn red, they turn warm, and they’re sensitive. This is because in those areas the blood vessels dilate, and when the blood vessels dilate, they become porous allowing and a lot of the immune cells into the damaged area to fight off these infections and clean up the area of dead tissue. These immunity cells seep through the blood vessels into the tissues that are inflamed and go to work by killing the germs or the pathogens. There are special immune cells that also clean up the area removing dead cells of the germs or pathogens, or cells of tissue that have been injured or have died due to the trauma that may have occurred and start the healing process. Acute inflammation is a good process, it basically helps and protects the body and starts the healing process. Chronic inflammation is where an area is chronically being irritated, and in this situation, this is not a good process. Chronic inflammation can cause deformities in that area can cause changes in the type of tissue there, and it’s even considered a possibility of what may cause or begin the cycle of cancerous cells. So we have physical injury, chemical injury, and pathogens. There are also other irritants to the body that occur, in our lifestyle for example, drinking too much alcohol can irritate the gastrointestinal tract, the stomach, and the throat lining. Obesity can result in several irritating aspects to the body. Chronic stress this can irritate and can cause inflammation. So, lifestyles can promote irritation. Differentiating between acute and chronic is straightforward, with acute inflammation it’s short term generally there’s pain in the area because that’s the area that has been affected. There is redness because of the blood vessels dilating, there’s usually a loss of function but that’s temporary, there’s swelling because the body tries to cushion the damaged area, so you get what we call edema fluid buildup in that area and you get heat. This is caused by dia dilation of blood vessels or should say an increase of blood flow to that specific area and the area feels warm to the touch.
Chronic inflammation is a little bit more difficult to pin down. Chronic inflammation can cause abdominal pain, you could have chest pain, fatigue, there may be fever joint pain, stiffness such as in terms of rheumatoid arthritis, skin rash such as psoriasis. Several different things and they don’t signal as quickly they’re not as easy to pin down versus acute inflammation because you know something has happened in an area with acute inflammation.
Foods that basically promote anti-inflammatory activity are tomatoes olive oil, green leafy vegetables, nuts like almonds and walnuts, and fatty fish like salmon mackerel and tuna, fresh fruits, strawberries blueberries cherries and oranges. Incorporating them in your diet can help as proactive anti-inflammatory agents. Obviously where there are foods to incorporate into your diet, there are foods to stay away from, refined carbohydrates such as white bread and pastries, French fries, soda, and other sugar sweetened beverages should be avoided, red meats are a definite, any processed meats can be irritants and inflammatory agents in the gastrointestinal tract.
So let’s talk about probably the most purchased, most utilized anti-inflammatory agents in this country and those are the non-steroidal anti-inflammatory drugs also sometimes known as NSAID’s. These medications come both in prescription strength and nonprescription strength. Because of these different strengths, the FDA has deemed that for the higher strengths there is potentially greater possibilities of side effects, also to take that strength I assume the FDA feels you should see some type of health care provider. The lower the strength the FDA feels that self-medication self-treatment is available and should be endeavored to be done because of the lower risk of side effects and adverse effect profile. In either case both medications, regardless of the strength, work the same way and how they work is they prevent a certain substance from being created or made that causes severe inflammation or causes inflammation in general. So, what are some of the common NSAID’s or anti-inflammatory medications that we can get prescription or over the counter that we utilize. Well, we have the ibuprofen, naproxen, aspirin is a non-steroidal anti-inflammatory medication. Aspirin, although I’ll be honest I I’ll talk about that a little later. There are a lot of warnings and precautions you need to deal with when taking about or taking or thinking about taking aspirin. You have a medication called indomethacin or Indocin, that’s another medication used as an anti-inflammatory medication. All of these are non-steroidal and when I say non-steroidal, they don’t come from the steroid class, don’t worry we’ll talk about those in another episode. Now people have asked, “how about Tylenol?” Tylenol is not an anti-inflammatory agent, Tylenol better known as acetaminophen has no anti-inflammatory properties, it’s a pain reliever it does reduce fever, but it doesn’t decrease inflammation, so it can’t be considered a non-steroidal anti-inflammatory medication.
NSAID’s can be prescribed by different routes for example or formulations include tablet, capsule, it’s in liquid form, many times you’ll find the NSAID’s for children with fever. Ibuprofen is used many times in a syrup or liquid form for children who have fever, it does reduce fever. The anti-inflammatory agents do reduce fever and let me again tell you that unless you’re taking aspirin for a specific purpose that your health care provider prescribed for I would avoid taking aspirin for any of its anti-inflammatory actions that you could use an ibuprofen or a naproxen for. There are just so many drug interactions and precautions you have to take An example being that you should never give any aspirin or aspirin combination product, of which there are many products out there, to adolescents or teenagers there’s a syndrome called Reyes syndrome which is life threatening to a child, adolescent, or teenager. Aspirin that can cause severe consequences with antiplatelet medications. So, if you’re on any blood thinners, taking aspirin is a contraindication. If you have asthma aspirin can trigger an asthmatic attack. I’ll go through this a little later concerning all the problems, side effects, and adverse reactions with aspirin. Overall I would avoid aspirin in any of these particular situations where you need an anti-inflammatory when you can go to an ibuprofen and naproxen or other NSAID then go to aspirin.
The NSAID’s are great for treating both acute inflammations caused by some type of trauma or pathogen, virus, or tissue damage due to some type of trauma and irritation. They are also excellent in use for treating chronic conditions, however when treating acute inflammation, you shouldn’t use the NSAID’s for more than three days, unless your doctor or your healthcare provider tells you can. There are reasons for this that I’ll get into concerning the side effects with the use of NSAID’s for long term use.
Not all NSAID’s may work for you, your physician or your health care practitioner may use a group of different NSAID’s and may find that one NSAID works better than another. So there’s no standard or hard fast rule that says a specific NSAID will work for you, if it does that’s great but if it doesn’t don’t feel that you’re locked into that one medication. Many times, people will try different medications, different NSAID’s, and they’ll find one that works the best
As for rheumatoid arthritis or for other types of chronic inflammation one of the differences you’ll find between that of over the counter NSAID’s versus that of prescription NSAID’s is the strength. You’ll find higher milligrams, higher dosage forms in prescription based NSAID’s then over the counter. The higher dosage forms are generally reserved for people who have severe inflammation such as with rheumatoid arthritis, osteoarthritis, severe muscle injury that’s when you generally would go to the higher dosage forms. The lower dosage forms that are over the counter are taken usually between two, three, or four times a day. Taking higher doses would be by prescription and would have directions. Over The Counter (OTC) medications should not be taken more than four times a day, and it’s important to understand that if you think you should take more because you feel that it would be faster in its activity or would be stronger, you also risk side effects.
let’s talk a little bit about some of the known adverse effects and issues you need to be concerned about when choosing and taking NSAID’s whether they are prescription or OTC. First and foremost are gastrointestinal problems, if you have been treated in the past for peptic ulcer or gastric ulcer or are currently being treated for that and sets are not a medication you want to take. NSAID’s can create or cause ulcers, they can aggravate if not create a problem with your gastrointestinal tract and potentially create ulcers. There were also renal or kidney problems so if you have any kidney problems being treated for them this is something again that you are going to have to your physician, or your health care provider should know about. Please be aware of cardiovascular or heart problems, as I mentioned earlier if you are on a blood thinner the NSAID’s can potentiate that problem and what I mean by potentiating a problem I mean they counteract that of the blood thinner.
I’d like to talk about aspirin, my pharmacy professor once said that if aspirin were discovered today, it would be by prescription only. Aspirin has quite several drug interactions as well as adverse effects in several different organ systems in our body. I would not use aspirin in any type of treatment for inflammation, there’s just too many issues and problems with aspirin and you have so many other choices.
So what are some of the common side effects of NSAID’s ? They can be gas or a feeling of bloating, heartburn, some stomach pains, nausea, vomiting, and maybe even some diarrhea. This can be prevented or controlled by taking it with food or if you can’t take it with food taking it with for example some type of antacid or coating agent. This will hopefully reduce the GI distress or prevent some of these side effects.
There are a few side effects that you really do need to contact your health care provider if they should occur. If you should ever find any kind of blood in your stools or in your urine, if you have severe stomach pain you should stop immediately taking the NSAID’s and contact your health care provider immediately. In cases where you are pregnant and you have inflammation, contact your health care provider to make sure that you can get clearance for taking them. I don’t recommend anybody who is pregnant to take medications over the counter or prescription before contacting that your OB GYN and making them aware and they’ve given the clearance for taking medication. I will have in my show notes a list of NSAID’s that are currently available, and a list of the types of side effects some general common side effects some of the more serious side effects that you should contact your health care provider for. so this ends this episode on non steroidal anti inflammatory medications treatment of acute and chronic pain and as always please read all the directions on any of the medications that are over the counter and follow all of the directions that your health care provider has for those NSAID’s that are of higher dosage.
What do you use NSAIDs for?
NSAIDs are used to treat:
- Pain of rheumatoid arthritis (RA), osteoarthritis and tendonitis.
- Muscle aches.
- Dental pain.
- Pain caused by gout.
- Menstrual cramps.
They can also be used to reduce fever or relieve minor aches caused by the common cold.
What are some prescription NSAIDs?
Here are a few examples of prescription NSAIDs. Some NSAIDs are only available as generic formulations (no brand names).
Generic names/common brand names
- Celecoxib (Celebrex®).
- Diclofenac (Voltaren® [available by brand name in topical form]).
- Fenoprofen (Nalfon®).
- Indomethacin (Indocin® [available by brand name in liquid form]).
- Ketorolac tromethamine (Toradol®).
Generic names (no brands)
- Meclofenamate sodium.
The most frequently reported side effects of NSAIDs are gastrointestinal (stomach and gut) symptoms, such as:
- Feeling bloated.
- Stomach pain.
- Diarrhea and/or constipation.
If you have any of these side effects, it is important to call your doctor right away:
- Black stools — bloody or black, tarry stools.
- Bloody or cloudy urine.
- Severe stomach pain.
- Blood or material that looks like coffee grounds in vomit (bleeding may occur without warning symptoms like pain).
- Inability to pass urine, or change in how much urine is passed.
- Unusual weight gain.
Head (vision, hearing, etc.):
- Blurred vision.
- Ringing in the ears.
- Photosensitivity (greater sensitivity to light).
- Very bad headache.