It is a matter of common sense that among all the medications on the market, both prescription and nonprescription, people tend to regularly take the medications that make them feel better.
Often these medications are the ones used for the symptomatic relief of minor acute (short-term) problems. The most commonly available medications for the relief of pain are over-the-counter analgesics. Many popular analgesics belong to the class of medicines known as nonsteroidal anti-inflammatory drugs.
NSAIDs include aspirin and other popular pain relievers such as Excedrin, Motrin, Aleve, ibuprofen and naproxen. They also are found in combination with other medications in popular cold and flu preparations available for use over-the-counter.
For short-term episodic use, NSAIDs are generally both safe and effective for otherwise healthy people. However, there is an interesting paradox, which is the medications helping you most can sometimes also hurt you the most. Each year, there are more serious health conditions and hospitalizations resulting from NSAIDs than from any other general class of over-the-counter drugs.
NSAIDs are very useful for a variety of health purposes. These medicines work by reducing inflammation and blocking pain. Unlike other NSAIDs, aspirin also thins the blood by partially blocking the mechanism for clot formation. Aspirin has proved effective at preventing heart attack and stroke in certain people at high risk.
The most common adverse effects from repeated use of NSAIDs involve the kidneys, stomach and liver. In general, people with chronic kidney and chronic liver disease should avoid the use of nonsteroidal anti-inflammatory medicines, which can contribute to further decline in the function of these organs.
NSAIDs also disrupt the natural mechanisms protecting the stomach lining from acid damage. This can result in stomach inflammation and the reflux of stomach acid into the esophagus (tube connecting the mouth and stomach) resulting in heartburn and/or upper abdominal pain.
Ulceration, which is a wearing away of the stomach lining, can lead to severe consequences, such as bleeding or even stomach perforation.
These more severe consequences are not common but can occur with prolonged, frequent and/or high dose use of NSAIDs. NSAID complications are also more common in the elderly and those with other chronic health conditions.
Regular use of NSAIDs may block the heart-protective benefits of daily aspirin use for people with chronic heart disease.
Also paradoxically, regular use of NSAIDs can occasionally cause the problem they are intended to treat. People who regularly take analgesics, such as NSAIDs for headache, may become dependent on the medication, which in turn increases headache frequency. This cycle of headache and medication use is known as analgesic rebound headache and is a leading cause of daily headaches.
Dr. Matthew A. Clark is a board-certified physician in internal medicine and pediatrics practicing at the Ute Mountain Ute Health Center in Towaoc.
