Here are a few things to know about anti-inflammatories

When Jeremy L. Knauff suffered injuries in the Marine Corps, he relied on pain relief medications like ibuprofen (Motrin, Advil) and naproxen (Aleve), otherwise known as nonsteroidal anti-inflammatory drugs (NSAIDs). Today, he doesn't go a day without chronic pain thanks to an autoimmune condition he's now suffering from, but this time, he wouldn't even think of using NSAIDs for relief.

According to the Merck Manual, pain is considered chronic if it lasts for more than three months, lasts for more than one month after the injury or disorder that initially caused pain has resolved, recurs off and on for months or years, or is associated with a chronic disorder (such as cancer, arthritis, diabetes or fibromyalgia) or an injury that does not heal. All the patients know is that they want to feel better.

“Every cell of my body is in constant pain, but I stopped taking NSAIDs about five years ago after taking them for more than 20 years because I learned that they were actually hurting me,” said the 43-year-old Tampa, Florida, resident. “Ironically, while NSAIDs are supposed to reduce inflammation, they also cause inflammation in the intestines, which makes autoimmune conditions worse.”

There are benefits to using NSAIDs. They reduce the sensation of pain. At higher doses, they reduce the inflammation that often accompanies and worsens the pain. Some patients, like Diane Reeder, depend on it. “I would sooner run out of bread, milk or eggs than my Aleve,” said Reeder, of Kingston, New York. “It's the only thing that helps with my inflammation so I can sleep.”

“NSAIDs reduce the immediate pain by inhibiting the formation of hormones known as eicosanoids,” said Dr. Barry Sears, author of the Zone Diet book series, and president of the Inflammation Research Foundation. “However, they also inhibit the formation of hormones known as resolvins that heal the damage caused by the inflammation. That's why they have side effects.”

These side effects include the risk of digestive bleeding, and studies released over the last few years have shown that there is also an increased risk of heart and blood vessel disorders with long-term use. “Over time, NSAIDs can affect normal functions of the body - including the GI system, heart, liver and kidneys,” said Dr. Harrison Linder, a pain management specialist with The Center for Interventional Pain Medicine at Mercy Medical Center in Baltimore.

“Anti-inflammatories also alter the blood flow to the kidneys, which increases the stress on the kidneys,” Linder said.

For four years, Sueann Souter McIntyre took daily naproxen to help combat her chronic arthritis pain. That is until her doctor told her she was in third-degree kidney disease. “Luckily, my damage was reversible,” said Souter McIntyre, a resident of Fishkill, New York.

In addition to cutting back, what should chronic pain patients use to relieve their pain? “There are different pain relief options - depending on the location of the pain - so there are spinal injections, muscle relaxants, nerve blocks and physical therapy, but we avoid opioids if we can,” said Linder.

According to the National Institute on Drug Abuse, roughly 21% to 29% of patients who are prescribed opioids for chronic pain, such as OxyContin and Vicodin, ultimately misuse them. Between 8% and 12% of opioid users will develop an opioid use disorder, and more than 115 people in the United States will die every day from an opioid overdose.

Since deciding to quit NSAIDs, Knauff has tried to rely on natural anti-inflammatories, stretching, and hot and cold therapies. If you still want to use NSAIDs, Linder urges patients to be careful how often they use them and to give their bodies a break - even just for a few days - if they are using them on a daily basis.

“You can alternate NSAIDs with acetaminophen, but Tylenol can affect the liver too, so be careful,” he said.