NSAIDs for Chronic Pain: Risks of Long-Term Use

Repetitive weekly and monthly use is linked to GI and heart issues

If you have chronic pain, chances are you've turned to nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief on more than one occasion. However, chronic or long-term use of NSAIDs—defined as more than three times a week for more than three months—can have negative health effects.

This article discusses the use of NSAIDs like ibuprofen and naproxen for chronic pain, how these drugs work, and how to take them. It also discusses the potential side effects and problems with the long-term use of NSAIDs.

Man taking medicine
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What Are NSAIDs?

Nonsteroidal anti-inflammatory drugs, or NSAIDs, are pain medications often used to treat muscle and joint pain, though they may be used for nerve pain in some cases. NSAIDs fall under the heading of non-opioid analgesics or non-narcotic pain medications. Typically, using NSAIDs for chronic pain is most effective when your pain is mild or moderate.

Unlike opioids, many NSAIDs can be purchased over the counter. Ibuprofen and naproxen, both NSAIDs, are readily available in drug and convenience stores. Prescription-strength NSAIDs for chronic pain are also available if your pain is more severe. In these cases, NSAIDs may also be combined with opioids to better control your pain.

How NSAIDs Relieve Pain

NSAIDs reduce pain in two ways. First, they alter the sensation of pain by blocking certain enzymes that participate in the pain response. Second, they work to reduce swelling that is often associated with certain types of pain. Some NSAIDs, however, are only effective at reducing swelling when taken at higher doses.

Most NSAIDs are taken by mouth, and their strength varies depending on the type of medication and dosage used. When you take NSAIDs for chronic pain, you may take a short-acting version combined with long-acting pain medication, such as an opioid or an adjuvant analgesic (an anticonvulsant or an antidepressant). This is especially true if you have breakthrough pain. However, a long-acting NSAID for chronic pain may be enough to control your symptoms.

Types of NSAIDs for Chronic Pain

Some of the more commonly available over-the-counter NSAIDs for chronic pain include aspirin, ibuprofen, and naproxen. These pain medications are sold in different non-prescription strengths and may be combined with other ingredients, such as caffeine or acetaminophen.

  • Prescription-strength versions of NSAIDs are available as well. Some commonly used prescription NSAIDs for chronic pain include Mobic (meloxicam) and Celebrex (celecoxib), a COX-2 inhibitor.

COX-2 inhibitors are a newer type of NSAID that selectively targets the COX-2 enzyme to ease pain and inflammation. COX-2 inhibitors have fewer gastrointestinal side effects than traditional NSAIDs but carry great cardiovascular risks.

Is Long-Term Use Safe?

When NSAIDs are used regularly over an extended period of time, as is often the case with chronic pain, the potential for side effects increases. Evidence suggests that the potential for NSAID-associated complications increases as you get older. Some more common side effects include:

  • Stomach irritation and ulcers
  • Gastrointestinal (GI) bleeding
  • Increased potential for bruising
  • Exacerbation of asthma symptoms
  • Increased risk of stroke, heart attack, and blood clots
  • Kidney damage

If you plan to be on NSAIDs for chronic pain long-term, your healthcare provider may alter the dosage. He or she may also provide you with other prescription medication that offsets the potential for developing any of the above conditions. The potential for NSAID complications may be increased if you:

  • Smoke
  • Drink alcohol regularly
  • Are a senior
  • Have a history of heart disease
  • Have high blood pressure
  • Have ever had any GI problems
  • Have kidney or liver disease

All NSAIDs, both prescription and over-the-counter, now sport warning labels thanks to a ruling by the Food and Drug Administration. Despite the warnings, using NSAIDs remains one of the most popular ways to relieve pain.

Frequently Asked Questions

  • What's considered long-term use of NSAIDs?

    Long-term or chronic use is defined as taking NSAIDs more than three times a week for more than three months.

  • What happens if you take NSAIDs every day?

    NSAIDs are fine to take on occasion, but long-term daily use can lead to side effects including stomach ulcers and gastric bleeding. In addition, non-aspirin NSAIDs can increase your risk of heart attacks and stroke. If you have ongoing pain concerns and find yourself reaching for an NSAID every day, talk to your doctor about other options for managing your pain.

  • Which NSAID is safest for long term use?

    All NSAIDs can have negative side effects from chronic use. The NSAID with the safest cardiovascular profile is naproxen. COX-2 inhibitors, like Celebrex, are associated with fewer gastrointestinal problems than traditional NSAIDs. Ibuprofen has the lowest risk of liver damage.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Zhou Y, Boudreau DM, Freedman AN. Trends in the use of aspirin and nonsteroidal anti-inflammatory drugs in the general U.S. population. Pharmacoepidemiol Drug Saf. 2014;23(1):43-50. doi:10.1002/pds.3463

  2. Merck Manual Professional Version. Treatment of pain.

  3. Cleveland Clinic. Non-steroidal anti-inflammatory drugs (NSAIDs).

  4. US Food & Drug Administration. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes.

  5. Mei J, Polyakova o, Shaliwall S, McDonald K, Wong AYJ. Safety and efficacy considerations for chronic use of NSAIDs for chronic pain. J Precision Med.

Additional Reading
  • American Chronic Pain Association. APCA Medications and Chronic Pain: Supplement 2007. 
  • The American College of Gastroenterology. The Dangers of Aspirin and NSAIDs. 
  • The Merck Manuals Online Medical Library. Pain: Treatment. 
  • The U.S. Food and Drug Administration. COX-2 Selective (includes Bextra, Celebrex, and Vioxx) and Non-Selective Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). 

By Erica Jacques
Erica Jacques, OT, is a board-certified occupational therapist at a level one trauma center.