Is this common pain medication wrecking your stomach?
As far as medical emergencies go, this one was at least pretty straightforward. On a cloudless early recent morning, I found myself careering toward the hospital in an Uber, my 18-year-old daughter sobbing beside me and puking into a plastic bag. Three days earlier, she’d had surgery to remove her wisdom teeth. Now, her insides were staging a violent rebellion. The source of her pain? Her pain reliever itself, in the form of a bottle of prescription strength ibuprofen.
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications in the world. They alleviate pain by blocking the production of the enzyme cyclooxygenase. That process in turn inhibits the production of prostaglandins, which leads to less swelling and inflammation. You probably have several over-the-counter and prescription NSAID varieties in your medicine cabinet right now — aspirin, ibuprofen, Naproxen, Celecoxib. They’re what you reach for when the menstrual cramps kick in, you overdo it at the gym, your arthritis or back pain flare up. Writing for Harvard Health in 2020, Robert H. Shmerling, MD, reported that roughly “15% of the US population takes an NSAID regularly (including those that are over the counter and prescription strength),” and that, along with “sporadic users,” adds up to “more than 30 billion doses … taken each year.”
Most of the time, taking NSAIDs is a good thing. Appropriate medication means not missing days of work or school. It means being able to participate in cherished activities. There’s even now a growing body of research into the use of NSAIDs in patients to help combat the opioid epidemic. With one-fifth of us living with chronic pain, managing it effectively is a serious issue — and a basic right.
NSAIDs can be hard on your stomach — harder than you may ever have bargained for.
But NSAIDs can be hard on your stomach — harder than you may ever have bargained for. Speaking to Mayo Clinic News Network in 2018, family physician Dr. Summer Allen noted that “one of our greatest concerns with NSAIDs for patients is the fact that it can lead to bleeding in their GI, or stomach lining or tract.” That can be particularly risky for people using them regularly or long-term. The Canadian Society of Intestinal Research estimates that “15–30% of long-term NSAID users are at risk of developing ulcer disease, with 2–4% of these ulcers leading to complications.”
Where things get even trickier — like, sitting on a stretcher hooked up to an IV drip for 12 hours-level tricky — is in the ever widening realm of adverse drug interactions, comorbidities and overprescription. Consumer Reports notes that “More than half of us now regularly take a prescription medication — four, on average.” And they don’t all play well together.
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Are you among the approximately 20 million Americans on antidepressants? A 2021 study out of Creighton University School of Medicine found that for patients already on NSAIDs, adding SSRIs meant “the odds of developing an upper gastrointestinal bleed increased by 75%.”
Are you on blood-thinning medicines, ACE inhibitors, beta blockers or other NSAIDs? All of those combinations can cause stomach irritation or other side effects.
Do you have Crohn’s disease? NSAIDs can make your symptoms feel worse.
Are you over 65? More than a decade ago, research in the journal of the American Medical Directors Association warned that chronic NSAID use “increases the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction” in the elderly.
By the time we heard the word “gastritis,” she’d been in the hospital for half a day.
But even for the otherwise perfectly healthy, there are important considerations to understand before taking NSAIDs. A 2016 report in the British Journal of General Practice warns, “From the first day of use, all NSAIDs increase the risk of gastrointestinal (GI) bleeding, myocardial infarction, and stroke.” And in yet another example of the boomerang effect, research out of Canada released just last month suggests that taking “drugs like ibuprofen and steroids to relieve short-term health problems could increase the chances of developing chronic pain.”
My daughter was, at the time of her oral surgery, already on two prescription medications, including the NSAID Naproxen. After her procedure, she came home with two more prescriptions — one for ibuprofen and one for antibiotics (which can also lead to stomach problems including diarrhea, cramping, and even in some cases C. Diff infections). In retrospect, it’s lucky she didn’t have a worse reaction to everything than she did.
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Her symptoms did not, at first, seem like they were NSAID-related. They didn’t even seem of a digestive system nature at all. Her initial complaint was intense back…
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