The Perils of Pain Medications


Helping You Understand the Health Risks of Pain Relievers

Every day more than 30 million people take over-the-counter and prescription drugs known as non-steroidal anti-inflammatory drugs or “NSAIDs” for effective relief from pain, headaches and arthritis.

These drugs have been around for a long time and have benefited many people.  Although they are generally safe, NSAIDs, like all drugs, do have some potential side effects.

Many people don’t know that NSAIDs can cause serious problems ranging from stomach upset to stomach bleeding, stomach pain, ulcers (a hole in the lining of the stomach) and even death. There is no medical test that can tell for sure if you will develop a problem, and in most cases these problems can happen without warning.  In fact, serious side effects of NSAIDs, such as stomach bleeding, result in nearly 103,000 hospitalizations and 16,500 deaths each year in the United States.  That’s more deaths than from AIDS and more than four times as many deaths as those from cervical cancer each year in the U.S.

Education is the first step in reducing your risk.  REDUCE ( R isk E ducation to D ecrease U lcer C omplications and their E ffects from NSAIDs) is a nationwide campaign created to help explain the potential harmful effects you could have if taking NSAIDs and help lower your risk for getting these problems.

What are NSAIDs?

NSAIDs are pain relievers that reduce pain and swelling at the site of injury.  About twenty NSAIDs are available with a doctor’s prescription.  Three of these, ibuprofen, naproxen, and ketoprofen, also are available over-the-counter.  The over-the-counter versions of some of these drugs are better known by names like Advil ® , Motrin ® , Aleve ® and Orudis. ® The only difference is that prescription versions are a higher strength than those purchased over-the-counter.  Other examples of NSAIDs include products with aspirin that are available over-the-counter, like Bayer ® and Excedrin ® .  NSAIDs also can be found in common cold and flu medications such as Advil Cold and Sinus ® , Dimetapp Sinus, ® Motrin IB Sinus ® and Aleve Cold and Sinus ® .  (Look for aspirin, naproxen or ibuprofen on the box or bottle to find out if your medicine contains an NSAID.)

Newer NSAIDs include meloxicam (Mobic ® ) and a class of drugs known as COX-2 specific inhibitors.  Examples of these drugs include celecoxib (Celebrex ® ), valdecoxib (Bextra ® ) and rofecoxib (Vioxx ® ).  These newer NSAIDs are available only through a doctor’s prescription and may be safer for the stomach.

*Acetaminophen (Tylenol ® ) is not an NSAID.

How do NSAIDs cause stomach problems?

Problems caused by NSAIDs can range from mild stomach upset to stomach bleeding and ulcers.  These problems occur because NSAIDs stop a substance in the body that protects the lining of your stomach from damage.  Some people may be at higher risk for stomach problems.

Are you at risk for NSAID-related stomach problems?

Everyone who takes NSAIDs can be at some risk for developing a stomach problem.  Below are some factors that doctors and pharmacists think are “high-risk” and may make you most likely to have serious side effects.

To find out if you fall within this high-risk group, fill out this simple REDUCE Your Risk Checklist. Mark all that apply to you.

Over the age of 60

Have had previous ulcers

Take steroid medications

(such as prednisone)

Take blood thinners              (such as warfarin or Coumadin ® )

Consume alcohol on a regular basis

Take NSAIDs in amounts higher than recommended on the bottle or by your doctor/pharmacist

Take several different medications that contain NSAIDs

Take NSAIDs for long periods of time

If you’ve checked any of the boxes in the checklist, take this brochure to your next doctor visit.  Talk with your doctor about how to lower your risk. You can also review the checklist with your pharmacist for advice about how to minimize your risk.  Remember that your pharmacist plays an important role in your healthcare team.  Pharmacists help you understand your medications to make sure you are using them safely and effectively.

A 2003 survey showed that almost half of Americans who took over-the-counter NSAIDs in the last year took more than the recommended dose. This can happen by:

  • taking the next dose sooner than directed on the label
  • taking more tablets/capsules at a single time than recommended
  • taking more than the recommended number of doses per day
  • taking several different medications that contain NSAIDs at the same time

Even taking small amounts of over-the-counter NSAIDs can increase your risk of developing stomach problems. This includes taking daily, low-dose aspirin to prevent a heart attack, stroke, colon cancer or several other diseases.

The Warning Signs

In addition to knowing your risks, it’s important to know the signs of a problem.  See your doctor immediately if you experience:

  • stomach pain
  • dark black, tarry or bloody stools
  • vomiting of blood or materials that look like coffee grounds

However, remember that about 80% of people who have a serious stomach problem as a result of taking a NSAID have no warning symptoms .  Problems can even occur within one week of starting to take these pain relievers.

REDUCE Your Risk

There are steps you can take to reduce your risk for developing a serious stomach problem.  The following are some important tips to guide you when taking any over-the-counter or prescription pain reliever

· Know your personal risk factors (review the “REDUCE Your Risk” Checklist).

· Since problems can develop even if you do not have any of the common risk factors, talk to a doctor or pharmacist before you begin taking any medication.  Also, ask questions and tell your doctor or pharmacist if you have any side effects.

· Read the label on your medications and follow the instructions.  Know all the ingredients in your medications, how much to take (dose) and length of time (duration) you can safely take the product.  Talk with your doctor before taking any pain reliever for more than 10 days.

· Take a medication only as directed and know its side effects.  Look for side effects on the label or box of every medication bottle.

· Never use prescription and over-the-counter pain relievers at the same time unless directed by your doctor or pharmacist.

· Write down all medications and dietary supplements that you are taking.  Be sure to include all vitamin, mineral and herbal supplements.  Share the list with your doctor or pharmacist, they can help you avoid drug interactions or ingredient duplications.

· Avoid or limit use of alcohol when taking any pain medication.

· Talk to your doctor or pharmacist about medications that can reduce your risk for developing stomach problems when taking NSAIDs.  Medications that decrease acid in your stomach, called proton pump inhibitors, can reduce your risk of stomach problems with NSAIDs.  Examples of these medicines are lansoprazole (Prevacid ® ) and omeprazole (Prilosec ® ).  Another medication, misoprostol (Cytotec ® ), is designed specifically to be taken with a NSAID to help reduce ulcers.  Other options include taking acetaminophen (Tylenol ® ) instead of a NSAID or taking one of the newer NSAIDs, including meloxicam (Mobic ® ) or COX-2 inhibitors, which may cause fewer stomach problems. Examples of COX-2 inhibitors include celecoxib (Celebrex ® ), valdecoxib (Bextra ® ) and rofecoxib (Vioxx ® ).  Also, consider not taking a NSAID at all.

· Talk with your doctor or pharmacist before beginning daily, low-dose aspirin.

· Talk with your doctor about pain that does not go away.

· Talk to your doctor or pharmacist if you are unsure if a drug contains a NSAID.


The REDUCE Campaign has been developed by the American Gastroenterological Association (AGA) and American Pharmacists Association (APhA) to increase awareness of the risks caused by over-the-counter and prescription NSAIDs.  The goal of REDUCE is to reach physicians, pharmacists and consumers through public service announcements and other educational materials.

Originally launched by the AGA in 1998, REDUCE has been brought back due to the need for greater education about the risks of NSAIDs.  For additional information, log onto

The REDUCE Campaign is supported by an unrestricted educational grant from Pfizer Inc.  AGA and APhA have complete editorial control of the content over this educational effort.