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Many of us reach for ibuprofen, aspirin, or another non-steroidal anti-inflammatory drug (NSAID) when we have chronic pain or inflammation. But despite their easy access, these drugs present serious health concerns. While we’ve known for some time that NSAIDs increase the risk of heart attack, but a recent literature review showed that all NSAID types were associated with increased heart attack risk, and the risk was greatest during the first month of use.

Taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of heart attack.

Greater risk was associated with higher doses.

When used for longer than one month, the risks did not appear to exceed those associated with shorter use duration.

Daily doses of 200 mg or more of celecoxib, 100 mg or more of diclofenac, 1200 mg or more of ibuprofen, and 750 mg or more of naproxen for just 8 to 30 days could raise heart attack risk.

For perspective, the recommended safe dose of ibuprofen is 1200 mg for menstrual pain — the same dose seen to raise heart attack risk — and 3200 mg for arthritis pain or fever.

Is a daily aspirin safe?

Many doctors recommend taking an aspirin to stop an impending heart attack, but as for daily use, aspirin’s heart benefits may be overshadowed by other concerns.

A 2018 study states, “The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.”

NSAID risk not limited to heart attack

NSAIDs such as aspirin, ibuprofen, and naproxen are the most prescribed medications for painful conditions such as arthritis, bursitis, and tendinitis. They come in many strengths and formulas in both generic and brand-name forms. Not only pain relievers, NSAIDs also reduce inflammation and fever and help prevent blood clotting.

NSAIDs work by preventing the COX (cyclooxygenase) enzyme from doing its jobs.

COX has two forms, each with its own duties:

• COX-1 protects the lining of the stomach from digestive acids and helps the kidneys maintain function.
• COX-2 is involved in the synthesis of prostaglandins that cause pain and inflammation in the body.

Traditional NSAIDs block the actions of both these COX enzymes, which is why they can cause upset stomach while relieving inflammation and pain.

COX-2 inhibitors are special because they only target the enzyme that stimulates the inflammatory response. Because they don’t block COX-1 activity they don’t cause the stomach upset commonly associated with NSAIDs.

However, COX-2 have serious side effects including abdominal pain, nausea, indigestion, and in rare cases, abdominal bleeding. Before use, talk to your doctor if you have a history of angina, heart attack, stroke, blood clot or hypertension or if you are sensitive to sulfa drugs or other NSAIDs.

Because NSAIDs block the stomach-protecting qualities of COX-1, they can cause stomach upset and bleeding, so take them with food to minimize risk. Other common side effects include:

• Heartburn
• Gas
• Bloating
• Vomiting
• Nausea
• Diarrhea
• Constipation
• Mild headache
• Dizziness
• Difficulty concentrating

If you have a health condition such as diabetes, liver or kidney disease, asthma, history of stroke or heart attack, Crohn’s disease, or pregnancy, talk with your health care practitioner before taking NSAIDs.

NSAIDs linked to leaky gut

An additional reason to avoid NSAIDs is their ability to promote leaky gut. In leaky gut, inflammation and damage to the lining of the small intestine causes it to become overly porous. This allows undigested food and pathogens such as bacteria and toxins to pass into the bloodstream, triggering a cascade of inflammation and pain throughout the body.

Quell pain without pills

Americans are in increasingly in pain from chronic inflammation caused by poor diet, stress, inadequate exercise, toxic load, sleep deprivation, unaddressed autoimmunity, and other factors of modern life.

Pain is the body’s way of telling us something is wrong. It’s important to address its cause early so you don’t suffer long-term effects.

In functional medicine, we address pain from various angles, and while pharmaceutical drugs may be necessary sometimes, there are many ways to reduce pain without taking drugs.

Anti-inflammatory diet. The foundation of any pain management plan, your diet should exclude foods known to wreak havoc on the immune system. Many patients do well by removing triggers such as gluten, excess sugars, processed oils, eggs, dairy, nightshades, and nuts.

Sleep. Getting enough sleep is one of the most underrated ways to reduce pain and inflammation. The amount of sleep you get directly affects the amount of pain you will feel in the following days. To improve your sleep, avoid screen time in the evening, stick to a regular bedtime and wake-up time, and work on balancing your blood sugar.

Yoga and meditation. These practices help quiet the brain and assist the transition from “fight or flight” mode to “rest and digest mode” where our bodies can heal.

Hydration. It’s easy to forget to drink water when we’re busy. We are made primarily of water, and dehydration adds to chronic pain. The best way to hydrate is to drink small bits all day long. Minimize caffeine and alcohol intake because they serve as diuretics.

Moderate exercise can reduce inflammation and relieve pain associated with immobility (just don’t overdo it or you’ll cause more inflammation).

CBD oil. Proving to be one of the best pain-relief options, many patients prefer CBD over opioids. Myth bust: CBD sourced from hemp is not psychoactive.

Boswellia. Available both as a tincture and as pills, this tree-based resin is known for its anti-inflammatory compounds and is said to rival the anti-inflammatory power of NSAIDs. Take it with a meal to avoid gastric upset, and check with your doctor if you are pregnant or breast feeding.

Turmeric and resveratrol. Powerful anti-inflammatories independent of each other, research shows they are much more effective together.

Support glutathione. The body’s master antioxidant, glutathione helps you detoxify, helps immune function, and shields cells from inflammation-based oxidative damage.

White willow bark is commonly used in place of aspirin for inflammation and pain.

Test for the root cause. Sometimes the cause of pain isn’t obvious such as a sprained ankle. A functional medicine practitioner can test you for nutrient deficiencies, underlying infections, imbalances in hormones, and environmental toxin exposure that contribute to chronic pain.

Managing chronic pain requires a commitment to diet and lifestyle changes, but when it’s done right, enjoying a pain-free life is possible. If you suffer from chronic pain and want to know more about how functional medicine can help you, please contact my office.