NSAIDs or non-steroidal anti-inflammatory drugs are back in the news. A British Medical Journal article says all NSAIDs increase heart attack risk. The report also states that the risk is highest in the first month of use and with higher doses. While the danger for an individual may be small it is bad news if you take these medicines regularly.
What are NSAIDs?
These drugs are common and widely available. Some are prescription only while others are sold over the counter. They are used for relief of pain, to reduce inflammation or to lower a fever. They might be taken for joint or muscle pain, sprains and strains. Or, to relieve headaches, migraine, period pain or toothache.
Some examples of NSAIDs and their trade names
- ibuprofen, brufen, advil, nurofen
- diclofenac, voltaren
- celecoxib, celebrex
- mefenamic acid, ponstan
- naproxen, naprosyn
- indomethacin, indocin
- sulindac, clinoril
- piroxicam, pirox, feldene
Side effects of these drugs are common. As well as the new findings on increased heart attack risk. Studies show that nearly all cause damage to the stomach and gut. Promoting a leaky gut, bleeding, inflammation and ulceration. With thousands of people hospitalised every year with these complications.
The newer drugs cause less harm to the gut. Yet they cause more cardiovascular problems such as stroke or heart attack.
This study suggests that 10% of kidney failures per year are due to overuse of NSAIDs.
Other studies suggest that NSAIDs may actually promote cartilage and joint destruction. Causing the symptoms they are supposed to treat.
Certain groups of people are at greater risk:
- people over age 65
- pregnant or breastfeeding mothers
- people with allergies or asthma
- previous NSAID allergy
- previous stomach ulcers
- history of heart, circulation or blood pressure problems
- history of liver or kidney problems
What are the alternatives to NSAIDs?
To minimise side effects guidelines recommend using NSAIDs at the lowest effective dose. And for the shortest possible time. But what are the options if you have a chronic painful condition?
Osteoarthritis is a chronic and degenerative condition. It involves joint pain and inflammation. With loss or damage to the cartilage surfaces and changes to the bone structure. Affected joints are stiff and movement is often restricted. It is a condition that causes a lot of disability and reduced quality of life. Yet conventional medicine is unable to halt its progression. Only aiming to decrease symptoms such as pain, with NSAIDs, steroidal joint injections or joint replacement. So is there any evidence of safe and effective alternatives to using NSAIDs?
The following alternatives are safe and effective treatments or strategies for osteoarthritis. With evidence based on scientific studies. They are mostly related to osteoarthritis of the knee. Since this condition creates much disability and there are plenty of studies available.
1. Diet – balance your fatty acids
It might surprise you to hear that certain foods can affect the amount of inflammation in your body. Most people have a high ratio of omega-6 to omega-3 fats in their diet, increasing inflammation. Increase the amount of omega-3 fats in your diet to reduce systemic inflammation.
Rich sources of omega-3 fatty acids are cold water fatty fish. These include trout, sardines, mackerel and salmon. Other sources include nuts such as macadamias and walnuts.
Omega-3 fatty acids in fish oil lower inflammation and reduce cartilage destruction. Studies show that fish oil supplements, especially EPA, may reduce the need for NSAIDs.
Have cold water fatty fish twice a week, and supplement with omega-3 fatty acids EPA and DHA on the other days.
Avoid rich sources of omega-6 fatty acids. These include processed vegetable oils, like sunflower oil. These promote systemic inflammation.
2. Weight management
Increased weight is directly related to the development of osteoarthritis. Reducing weight can be a major factor in preventing or managing arthritis of the knees.
Studies show that exercise reduces arthritic pain and improves joint function. A range of activities provides the most benefit. So, weight bearing, aerobics and stretching are all necessary. Strengthening the surrounding muscles is important to stabilise joints. Preventing the muscle weakness that promotes structural damage.
Weight bearing exercise helps to prevent loss of cartilage and bone. Activities such as yoga that improve flexibility and range of motion are beneficial. Water based activities such as swimming or pool aerobics are a good option.
Aim for some physical activity on most days. For a total of 150 minutes moderate exercise per week, or 75 minutes vigorous exercise. Where possible, more exercise or higher intensity exercise is more beneficial.
Bromelain is a protein digesting enzyme, found in the stem and fruit of pineapples. It is available as a dietary supplement. Bromelain relieves osteoarthritis because it is an anti-inflammatory agent with analgesic properties. There are several studies supporting its use for this condition.
Bromelain is effective for mild to moderate knee osteoarthritis. Reducing pain and stiffness and improving joint function. There was no difference between treatment with diclofenac and bromelain, at 4 weeks. Using 500mg/day bromelain, compared to 100mg/day diclofenac.
A recent meta-analysis compared a protease and bioflavonoid product containing bromelain, with diclofenac. The analysis covered safety, efficacy and tolerability of treatments for osteoarthritis. The protease and bioflavonoid product was superior to diclofenac. Researchers described it as suitable for high-risk patients. As well as for daily managment of osteoarthritic joint pain.
Yet another trial tested a combination of three natural anti-inflammatory agents. These were bromelain and the herbs turmeric and devil’s claw. The combination reduced pain in acute and chronic osteoarthritis. Researchers declared there were no withdrawals from the trial due to side effects. Suggesting the combination was a safe and efficacious alternative to NSAIDs.
Many cases of osteoarthritis respond very well to herbal treatment. I have discussed herbs for osteoarthritis before. Yet this condition does tend to need ongoing treatment. With this in mind the following herbs have good evidence of efficacy.
Boswellia serrata is probably better known as frankincense. Oral treatment and topical treatments are available. This study compares capsules only with a combination of capsules plus topical use. Researchers report moderate improvement in both groups.
Many of the studies of Boswellia for osteoarthritis are product combinations. This study compared standard management of osteoarthritis with a commerical product, Movardol. The product contains N-acetylglucosamine, Boswellia serrata and ginger. The study took place over 6 months and treatment was considered well tolerated. The supplement was found efficacious for management of moderate knee osteoarthritis.
6. Willow bark
Many people are aware of the connection between aspirin and willow bark. Aspirin is derived from a similar compound to one found in willow bark. However, recent studies have shown only low levels of salicin in willow bark. In amounts unlikely to be responsible for its medicinal effects.
So, while willow bark does posses potent analgesic and anti-inflammatory effects. It is a stomach friendly herb. Causing none of the gastric irritation of aspirin. Yet, with a tradition of use for pain and osteoarthritis.
7. Pine bark extract
Pycnogenol or pine bark extract improves mild to moderate osteoarthritic symptoms. This study shows it is able to allow the use of lower doses of NSAIDs. Patients took either placebo or 150mg per day of pycnogenol for three months. The treated group had a significant reduction in pain. While the treatment was well tolerated.
A similar study used a lower dose of 100mg pycnogenol per day. With similar outcomes after three months of treatment. On the whole, the treatment group could walk three times further after three months. They also had less need for anti-inflammatory drugs.
Acupuncture has been used to relieve pain for thousands of years. Yet it is difficult to produce gold standard research due to the lack of suitable placebo. Still, some studies are available.
A meta-analysis of electroacupuncture for knee osteoarthritis found results that were better than for drugs. A minimum of four weeks of treatment alleviated pain and improved function. There was a low risk of side effects.
A similar treatment to acupuncture is moxibustion. Dried plant material is burned near the skin surface, at acupuncture points. A recent review of moxibustion treatment for osteoarthritis was compared to sham moxibustion. The treatment group had more reduction in pain. In fact, pain reduction was the same or better than steroid injection or topical drug treatments.
In another study, patients were taught to apply acupressure. They applied self-acupressure for 5 days a week for 8 weeks. For a significant improvement in pain and physical function after 8 weeks.
These studies indicate that there are several possibilities for alternatives to NSAID use. Of course it is likely that a combination of some of these treatments will provide a better overall outcome. It is also important that relevant advice is taken to ensure treatments are safe for any individual.
Now, have you tried any alternatives to NSAIDs? Please share your experiences in the comments box.