How NSAIDs Work

Once upon a time there was a guy who had a massive headache. His friend suggested he take a Tylenol. "No thanks." Said the guy. "I'll take an aspirin NSAID!"

Today's topic: Non-steroidal anti-inflammatory drugs and why you probably shouldn't take them all the time.

What It Is
Before anything else, you should probably know what inflammation actually is. If you aren't already familiar with it go watch this Khan Academy video about the inflammatory response. I'll wait here.

Now then, when you're in pain, you usually have two options you can buy instead of going to a doctor. The first is Paracetamol/Acetaminophen (E.g. Tylenol, "Asprin Free" painkillers, Panadol)*: Mild painkillers that aren't very good at keeping inflammation down. You won't hurt as much, and if you have a fever, it will be reduced, but any redness or swelling you may be experiencing won't go away.

The second, NSAIDs, are drugs which work to both relieve pain, and suppress the body's inflammatory response to pain and injury*. Over-the-counter medication in this category usually has one the the following three drugs as it's active ingredient:

Ibuprofen (Advil, Brufen, Motrin, Nurofen)
What It Is: Patented in 1961, ibuprofen is used primarily for pain, fevers, cramps, and inflammatory diseases. It's more stable than aspirin, so it can be used in topical medicine as well as in pill form.
How It's Taken: Orally, topically, intravenously, and rectally.

Benefits: Effective, stable (so you can use it in gel or just swallow a pill), lasts a 4-8 hours
Also, according to a study published in 2005, taking Ibuprofen on a regular basis may also help delay or prevent Parkinson's disease. More research needs to be performed before it can actually be recommended for this purpose, however. Also, of the NSAIDs, only Ibuprofen use was shown to correlate to the lower risk. Taking Naproxen or Aspirin didn't affect one's chances at all.
Side Effects: Ibuprofen is rough on your digestive system. Taking it can result in everything from nausea to stomach-bleeding, especially if you've been drinking.

Naproxen (Aleve)
What It Is: Prescription-only in most parts of the world, but made available OTC in the United States in 1994, in the United Kingdom in 2008, and most parts of Canada in 2009. Usually used for reducing pain caused by headaches/migraines, arthritis, and menstrual cramps.
How It's Taken: Orally.


Benefits: Good at helping with menstrual pain, can help in the diagnosis what may be causing a fever (PDF).
Side Effects: Same as ibuprofen.

Aspirin (acetylsalicylic acid)
What It Is: Comes from willow bark. Anti-inflammatory, reduces fevers, and it prevents platelet molecules from sticking together (which is why, in addition to acting as a painkiller, people who are at risk of heart-attacks/strokes/blood clots are advised to take small doses on a regular basis.)
How It's Taken: Orally, sometimes rectally. A soluble form of aspirin can be given intravenously, too.


Benefits: Taking aspirin on a regular basis may help prevent cardiovascular trouble in certain types of people, but not everyone. In fact, people who aren't already at risk of heart disease have been advised not to take on a regular basis at all, as risks of regular use lead to...
Side Effects: Higher risk of age-related macular degeneration, and aspirin resistance. Also the same gastrointestinal side effects associated with the use of naproxen and ibuprofen.

*Right about now I'm willing to bet some of you are wondering what the hell Midol is. Well, that, my friends, depends on the formula. Midol and its generic siblings are actually made of either an NSAID or acetaminophen, depending on which one you buy.

How They Work
In the simplest of terms: acetaminophen works by blocking pain receptors so you don't think you're in pain, and NSAIDs work by actually depressing the inflammatory response. Here's how:

1. Under normal conditions, the an enzyme called Cyclooxygenase (COX) is responsible for the creation of signaling molecules called prostaglandins, which are in turn the chemicals which promote the inflammatory response and prevent your stomach from eating itself (thus why you can end up with stomach problems when you start taking something which affects the production of these things.)
Here, the wall is a metaphor for your skin and stomach walls and stuff basically anywhere that can be infected or damaged. It's being tagged to prevent bacteria from moving into this area. This here is human territory, stay out. Unfortunately this isn't exactly high-quality street art, it's just the inflammatory response.

2. NSAIDs work by COX blocking. Once NSAIDs are introduced to the system, COX is prevented from producing prostaglandins, so inflammation, fever, and pain are reduced.


The Bottom Line
In addition to the drug-specific side effects listed above, regular use of analgesics (Including acetaminophen)  has been linked to a higher risk of: hearing loss and erectile dysfunction in guys; miscarriage in women; and hypertension, strokes/heart attacks (PDF), kidney cancer, in everyone.

These aren't vitamins, kiddos. They're loose canons, but they're still damn good cops If you're in pain, go ahead and take them whenever you need (within safe limits), but don't drink when you do, and if your pain sticks around for longer than it should, see a doctor already, because something's probably actually wrong.

("Oh no you've left out alternative medicine." Says the hippy in the back. "Quiet, you." I respond. This blog is about actual medicine. . I've had quite enough emails from you people about your placebo-effect-powered snake oil thank you very much.)