Picking the Right NSAID for OA Pain

A key medication for osteoarthritis pain relief is a class of drugs called nonsteroidal anti-inflammatory drugs or NSAIDs. Available in prescription and over-the-counter strength, there’s a lot to choose from when treating osteoarthritis or OA. Learn more about NSAIDs and how to determine which is best for you.

Traditional NSAIDs block two enzymes – cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) – that produce prostaglandins, which cause pain and inflammation. The original NSAIDs are called salicylates, which includes aspirin. Nonacetylated salicylates don’t contain aspirin and are designed to have fewer side effects. Selective COX-2 inhibitors were designed to be easier on the stomach by only blocking COX-2 enzymes.

NSAIDs are available as pills, suppositories, liquids and topical gels and patches – and in fast-acting and long-lasting formulas. You may take or apply an NSAID once a day or several times. Researchers say both oral and topical formulations are effective for pain, but topical NSAIDs may be better for pain near the surface of the skin, such as the hands and knees. Oral NSAIDs may be better for body wide pain or pain deep within your body.

Some NSAIDs, like standard ibuprofen, must be taken every four to six hours; others, like naproxen, are taken every 12 hours. Some prescription NSAIDs come in long-acting or extended-release forms, which can be taken once every 24 hours. Once-a-day dosing may be desirable if you take multiple medications.

With close to 20 different NSAIDs on the market, it will take trial and error to find what works best for you. Just as people’s bodies are different, so are their responses to certain drugs. Two people can take the exact same dose of the exact same drug but have different responses. Always follow dosing instructions carefully.

NSAIDs may cause gastrointestinal (GI) bleeding (bleeding in the stomach or digestive tract). Topical NSAIDs may pose less risk than oral ones because the drug stays close to the site of application. COX-2 inhibitors have a lower risk of causing ulcers. The risk of stomach problems increases for people who are over 65, have history of stomach ulcers, and take blood thinners or corticosteroids. Alcohol can worsen stomach problems.

All NSAIDs, except for aspirin, increase the risk of heart attack or stroke, especially for those with existing heart disease or risk factors for it. These serious side effects can occur within the first few weeks of using an NSAID. The risk of cardiovascular side effects increases the longer people take them and at higher doses.

Reduce your risks of GI or cardiovascular problems by taking the lowest effective dose of an NSAID for the shortest time possible. However, some health conditions – such as having a history of kidney disease, heart disease or stomach ulcers, for example – may put NSAIDs completely off-limits.

Together with your doctor, you can determine if NSAIDs can help with your osteoarthritis and to find the right one for you. Learn more about NSAIDs with our Drug Guide.