Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are commonly used drugs for those experiencing pain. They are often used to help avoid addictive and harmful drugs such as opioids.. Many know what Advil, Aleve, and Motrin are, but not many understand why they seem to work well and what makes them popular.
NSAIDs and How They Work
NSAIDs are often used to treat pain, fever, and overall inflammation, hence the “anti-inflammatory” portion of the name.
NSAIDs block a specific group of cyclooxygenase or COX enzymes from their role as oxidizers. The COX enzymes are important in the inflammatory process as they oxidize the substrate, arachidonic acid, into endoperoxides, which differentiate into inflammatory molecules called prostaglandins, prostacyclins, and thromboxanes.
Each of these three enzymes signals responses that increase pain and inflammation:
- Prostaglandins increase bodily temperature.
- Prostacyclins decrease vasodilation.
- Thromboxanes increase vasoconstriction and affect platelet adhesion.
Different Types of NSAIDs
Since the inflammatory response can be affected by many different chemical structures and reaction selectivity, many different drugs have been created.
Some of the most common NSAIDs are:
- Ibuprofen (Advil and Motrin)
- Indomethacin
- Meloxicam (Mobic)
- Naproxen (Aleve)
- Diclofenac
- Celecoxib (Celebrex)
Each NSAID is grouped and differentiated by its chemical makeup and selectivity.
All NSAIDs are either Non-selective or COX-2 selective, with most being Non-selective. Non-selective NSAIDs will target both COX-1 as well as COX-2. The only NSAID listed that targets COX-2 exclusively is Celecoxib.
Difference Between COX-1 and COX-2
COX-1 and COX-2 both oxidize arachidonic acid into prostaglandins, prostacyclins, and thromboxanes. The difference between the two enzymes is that COX-1 is constitutive, and COX-2 is expressed only in response to inflammation.
Since the COX-1 and COX-2 enzymes differ in non-inflammatory roles, the side effects of inhibition will also vary.
COX-1 plays a role in keeping a healthy mucus lining in the GI system and regulating healthy kidney function, which is the reason for constant expression. If inhibition of this expression exceeds a certain length of time, GI and kidney function will start to decline.
This potential side effect is why patients with GI and kidney conditions should be cautious about NSAID use.
NSAIDs Use at Cantor Spine Center
As a practice intensely focused on minimally invasive pain treatment, we tend to prefer NSAIDs as a starting point for eligible patients with inflammation. This allows us to determine the pain’s magnitude and the best course of action.
Our use of NSAIDs in conjunction with other conservative measures, such as physical therapy, has allowed us to successfully treat numerous patients without the interventions of injections or surgery.
If you would like to learn more about NSAIDs or would like a professional consultation on your eligibility for NSAID use, click here!