There are several types of NSAID’s, roughly 20-30 available products, but there is little evidence that one has a better effect on pain than another. Because of the large number of NSAID products, we will only discuss the most common ones used in palliative care here.
Aspirin
Aspirin is the original NSAID. Like acetaminophen, aspirin can be combined with opioid analgesics to optimize pain management. Aspirin is generally not used in palliative care patients, however, because of the risk of stomach upset and increased bleeding. Many patients with chronic illnesses that have an increased risk of heart attack or stroke are prescribed an 81mg “baby” aspirin per day.
Ibuprofen and Naproxen
Both ibuprofen and naproxen are available over-the-counter. Both can be combined with prescription opioid medications as well. Ibuprofen is usually dosed ever 4 to 6 hours while naproxen is available in sustained-release form for twice a day dosing. Ibuprofen is available in a liquid form for patients that can’t swallow pills while naproxen is only available in pill form.
Ibuprofen is available over-the-counter, usually in 200mg tablets. The usual dose is 200-400mg every 4-6 hour. Ibuprofen is also available as a prescription in 600 and 800mg tablets. It should not be used for more than 10 days at a time unless prescribed by a physician
Naproxen is available over-the-counter with the usual dose being 250-500mg twice a day. It is also available as a prescription controlled release tablet that is taken once a day.
The most common side effects from ibuprofen or naproxen are rash, ringing in the ears, headaches, dizziness, drowsiness, abdominal pain, nausea, diarrhea, constipation and heartburn. Both medications increase the risk of bleeding and stomach ulcers. If you are going to be on an NSAID for an extended period of time, your doctor may also prescribe medications to protect your stomach.
COX-2 Inhibitors
The newest class of nonsteroidal anti-inflammatory drugs is COX-2 inhibitors. They work much like traditional NSAID’s but carry a lower risk of stomach ulcers and bleeding. They are available only by prescription.
COX-2 inhibitors, like celcoxib (Celebrex) can carry an increased risk of heart attack or stroke. This risk increases the longer you are on the medication. This risk may or may not be one you are willing to take based on your goals of care.
*A Note About Benefits VS Risks
Sometimes in palliative care and hospice, long term risks aren’t as important to the patient or family because the immediate benefits are worth it to them. For example, someone who has a terminal illness with a life expectancy of two months or less and also suffers from severe arthritis may decide to risk any side effects of NSAID’s to have relief from pain. These decisions are best made with your doctor.
