Non Steroidal Anti-Inflammatory Drugs (NSAIDs) are medications which, as well as having pain-relieving (analgesic) effects, have the effect of reducing inflammation when used over a period of time.

NSAIDs can be used as simple pain killers (analgesics), but paracetamol is usually preferable, as it is likely to have less unwanted effects, and costs less. They are most useful in conditions which cause inflammation. The anti-inflammatory effects may take from a few days to three weeks to come on, so it is worth persevering for a while before deciding that a NSAID is not going to help.

NSAIDs are used as follows:

• The commonest use of these drugs is for arthritis. Paracetamol is often adequate for osteoarthritis, but NSAIDs are particularly useful in the inflammatory forms of arthritis (rheumatoid arthritis) and, sometimes, in the more severe forms of osteoarthritis.
• Back pain and sciatica. Ibuprofen has been clearly demonstrated to be helpful, and the other NSAIDs are also helpful.
• Sprains, strains, and rheumatism.
• Dental pain.
• Post-operative pain.
• Period pain (dysmenorrhoea) and heavy periods (menorrhagia).
• Pain from kidney stones (renal colic).
• To help reduce temperature in someone with a fever.
• Migraine.
• Other painful conditions, especially where there is inflammation.

The NSAIDs work by affecting some chemicals in the body which cause inflammation, the prostaglandins. Unfortunately the same group of chemicals are involved in the stomach, and so the NSAIDs tend to cause indigestion, and may even cause duodenal or stomach ulceration.

As a result of this side-effect they cannot be used in someone with a history of peptic ulcer, except in exceptional circumstances, under close medical supervision. Also they would rarely be used and, if used, only with extra care, in somebody with heartburn or indigestion.

In general, the more effective a NSAID is at reducing inflammation, the more likely it is to cause indigestion. Sometimes your doctor will prescribe them along with something to cut down the risk of ulceration. There is even one medication that contains both components together.

There have been recent advances, in that some NSAIDs are said to be more specific in dealing with inflammation and less likely to irritate the digestive (gastrointestinal) system, but nothing has yet overcome this problem altogether.

The drugs vary in strength and side effects. Usually, as with other medications, the more effective they are, the more side-effects they are likely to have. Aspirin, which originated from willow bark, has been around for a long time and is in many people's medicine chests. This is an anti-inflammatory analgesic. Most NSAIDs also reduce the temperature in someone with a fever.

Of the newer medications in this group, the one in widest general use is ibuprofen, which is available over the counter in many countries. There are a large number of other NSAIDs, most of which have to be obtained on prescription in the UK.

Those most used in UK, after ibuprofen, are naproxen and diclofenac.

There are many other potential side effects, but these vary according to the drug chosen and the individual taking it. The other side effects are far less likely to occur.

Specific allergy to a NSAID can be quite dramatic, with rash, swelling of the face, and sometimes difficulty breathing. (If this happens you should call for help urgently.) As with other drugs, if you get a reaction which you suspect to be a side effect, stop taking it and check with your doctor. Sometimes, if the reaction involves an itchy rash and or swelling, it is worth trying an antihistamine in the meantime.

Some people with asthma react to the NSAIDs by getting more wheezy. If this happens you should stop the drug, and use your usual asthma medication, calling the doctor if this does not work.

NSAIDs cannot be used (are contraindicated) in the following cases:

• Allergy to aspirin or any NSAID
• Aspirin should not be used under the age of 16 years
• During pregnancy
• During breast feeding
• On blood thinning agents (anticoagulants)
• Suffering from a defect of the blood clotting system (coagulation)
• Active peptic ulcer

Care is needed if you have:

• Asthma
• Kidney impairment
• Heart impairment
• Liver impairment

These drugs are available in nearly every form:

• By mouth, they come in tablets, capsules or medicines. This is the most widely used form.
• Some NSAIDs are available as injections. This form is used for the pain after surgical operations and also is very effective for the treatment of pain produced by kidney stones (renal colic).
• Suppositories are available. These are often used for post operative pain and sometimes in chronic pain when the patient is unable to take medication by mouth.
• Creams, gels and foams to apply to the skin. These are not felt to be as effective, but some people do get considerable relief from their use.

Although non-oral routes of administration avoid the direct irritation of the stomach, they do not avoid the indigestion and ulcer risks, as these are caused by the chemical once it is in the blood stream.