NSAIDs: the Good and Bad

Are you one of the thousands of people who take anti-inflammatories daily to make it through the day? Many people who are suffering from headaches, pains or aches reach for these products to help relieve pain- because they are effective, but few of these people are aware of the potential side effects. We would be remiss if we did not speak of anti-inflammatories broadly because of how broad this class of substances is. There are synthetic as well as natural anti-inflammatories. Among the synthetic anti-inflammatories are Nsaids and steroidal anti-inflammatories which are used for serious medical conditions and are only available under a doctor’s prescription. The natural anti-inflammatories include a very large selection of foods and food extracts which many people find to be helpful, but their availability does not seem to have slowed down the use of NSAIDs among the general public.


In terms of NSAIDs, or non-steroidal anti-inflammatories, it is probably unrealistic not to recognize that the discussion of NSAIDs almost always, really, is a discussion of pain relivers. The vast majority of people taking NSAIDs are not taking it because they care one bit about COX 1 vs COX 2 or Inflammation. they are taking them because they care about pain. If I take this thing my pain will go away is the common thinking.

These NSAIDs are very effective at taking pain away which is why they have become a benchmark in the pain management landscape. Grocery stores, drug stores and even convenience stores have shelves full of anti-inflammatories of many, many brands of many different products- like ibuprofen, naproxen, diclofenac, celecoxib, mefenamic acid, aspirin and others.

NSAIDs and the Effects on the Heart

If it were more widely understood by the general public, the likelihood of increased atherosclerosis and coronary artery disease[2] that come with prolonged use of synthetic NSAIDs, people would probably rely on them less. The hallmark study [1] was performed when Pfizer Pharmaceuticals was preparing to launch their flagship COX 2 inhibitor, Vioxx. These COX 2 inhibitors were going to be the anti-inflammatories that could be given to people regularly without the risk of ulceration that we run into with the other Cox inhibitors.

The people at Pfizer also understood that the disease that we call atherosclerosis, or the plaquing of the arteries, is not really essentially a disease of cholesterol, it is really a disorder of inflammation. The artery undergoes an inflammatory event, probably an injury and then an inflammation. Subsequent to that inflammation the artery is patched or repaired with cholesterol that turns the artery from a muscular, flexible elastic tissue, into a hardened, unyielding tube. The cholesterol was not as much as the culprit, as it becomes what the body uses to make the failed repair: inflammation was the culprit. Pfizer understood this and as they were preparing to launch Viox, their flagship Cox 2 inhibitor, they staged a very large study. The study was a large population of people that were given the NSAID every day, prophylactically, with the intent that it would inhibit inflammation and by inhibiting inflammation we would have less atherosclerosis, less coronary artery disease and less cardiovascular incidents: heart attacks, strokes, death. This study measured how much of these coronary adverse effects they were having. This study was halted before it could finish because it turned out people were having increased morbid side effects when they were taking the Vioxx.

Vioxx was given the dreaded black box warning, almost the kiss of death for any new drug. Later studies revealed that this was not Vioxx alone, and many of the NSAIDs that people take regularly had these effects.[3] Subsequent studies have perhaps minimized the risk, but no one has disproved the risk. Most of us out here in the field of healthcare recognize that we are doing best by our patients if we minimize their exposure to NSAIDs.


Other Effects

 gastrointestinal (GI) bleeding [4]
 myocardial infarction
 stroke
 fatal cardiovascular events
 risk of acute kidney injury
 precipitate bronchospasm
 rise in HbA1c in type 2 diabetes



There are non-anti-inflammatories that do a great job at reliving pain without all of the side effects of NSAIDS. Things like lidocaine, Biofreeze, Cryoderm, capsicum preparations and other topical products of which there are many.

NSAIDs in Chiropractic Care

If you come to a chiropractor, you would probably expect to hear something like “hugs not drugs”. Chiropractic is classically the drug-free, pain management model. I think our position in chiropractic as the drug-free, pain management model is very, very valuable and it makes us useful in many situations where drugs cannot be employed. That does not mean that there are not some applications for these products in some cases.

Very commonly the management of a person chiropractically doesn’t simply involve adjustments. It involves managing chronic inflammation and chronic tissue quality issues that are simply not going to be treatable without actually creating some inflammation and/or managing this inflammation. When managing these complicated cases, NSAIDs become useful.

Anti-inflammatories have their place. We hope you may think before reaching for them daily and search for other solutions to your pain. Of course, when you just will not make it through a day without them, do not suffer. Be mindful of how much and how often you are taking them and start searching for other pain-relieving alternatives. Using pain relivers only to relieve pain is like covering your check engine light with a piece of tape. A better scenario is taking steps to manage your pain and allowing the pain relivers to help facilitate that process.


[1] https://www.npr.org/2007/11/10/5470430/timeline-the-rise-and-fall-of-vioxx
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5422108/
[3] https://www.ahajournals.org/doi/10.1161/circulationaha.113.004480