Medically reviewed by, Russell Braun RPH
Pain is a growing concern for more and more people. It is the number one syptom reported in visits to primary care doctors. The number of people living with chronic pain is estimated to be 20% according to the CDC. That means a lot of people are looking for pain relievers.
NSAIDs also know as nonsteroidal anti-inflammatory drugs, are probably the most commonly used pain medications. However, they can lead to gastrointestinal and kidney side effects. These effects can be magnified in people 65 and over. In fact, the research suggests that NSAIDs are responsible for up to 25% of all adverse drug reactions.
Despite this fact, NSAIDs are often bought by seniors at the drugstore. Perhaps even worse, NSAIDs are often prescribed to older adults by physicians, because the anti-inflammatory effect can provide relief from arthritis pain, gout, and other common health ailments.
So finding non NSAID pain releivers is important!
1. First Try Non Drug Options
It is important to remember that drugs are not always the answer. In addition, every medication you take has the potential for side effects. Therefore, finding non drug options that can help is the best possible solution. The table below lays out the best non drug options for combatting your pain.
|Biofeedback||Low inflammatory diet||CBT|
|Joint supporting splints||Relaxation therapy|
Although it may seem counterintuitive to exercise pains away research has shown exercise can lessen pain. You should be working with your doctor to find out what kind of exercise to do that will be therapeutic for your particular pain. The benefits of exercise for people with pain include:
- Increased strength
- Aerobic capacity is increased
- Better balance
- Increased flexibility
- Posture is improved
- Improved mental outlook
- Endorphins released increase positive outlook
- More energy overall
Too many people discount the improvements they can make by using physical therapy. All sorts of medical conditions can benefit from these practices. Building muscles to support parts of the body causing pain can be a very effective approach to treating pain. In addition physical therapy can help increase:
- Range of motion
- Physical function
In addition, there is a low risk of injury or side effects from physical therapy.
A meta analysis in the Journal of Pain found that acupuncture can reduce symptoms of chronic pain. Overall, patients receiving acupuncture had less pain compared to control groups. The study looked at osteoarthritis, headache, back pain and neck pain.
This is a process of becoming aware of things that are happening in your body to help you get control of them. A therapist will use electrical sensors attached to areas of the skin that measure things like heart rate, breathing rate, blood pressure and muscle activity.
The idea is to determine when changes like these are occurring and how it is causing you pain. Once you are aware they are occurring you are provided ways to try and stop the response. Biofeedback has been studied and shown effective. A few techniques are used to help relax your mind and body such as:
- Muscle tightening and relaxation
- Guided imagery
- Deep breathing techniques
Low Inflammatory Diet
One of the best ways to eliminate pain in the body is to reduce inflammation. Many people don’t realize how much inflammation a bad diet can cause. The good news is this doesn’t have to be a specific diet, but instead can be a collection of foods you should eat. Things to eat to lower inflammation include:
- Colorful fruits and vegetables. French fried potatoes don’t count!
- Fish that contain omega 3 fatty acids, which are proven to lower risk of heart attacks.
- Whole grains that contain fiber such as oatmeal, brown rice and wheat bread.
- Beans that are also high in fiber and feed your microbiome.
- Nuts and oils like olive oil. They have healthy fats that lower inflammation in the body.
- Spices such as turmeric, which is found in curry, is a potent anti-inflammatory.
Conversely, an easy thing to remember are the foods to stay away from. Such as things that are fried, overly sweet or highly processed. A great rule of thumb is shop around the perimeter of the grocery store. Typically everything in the middle is going to be processed food.
Cognitive behavioral therapy (CBT) focuses on the thoughts and feelings you are having and how it affects your behavior. CBT involves a structured approach that focuses on the relationships among cognitions (or thoughts), emotions (or feelings), and behaviors.
Treatments based on cognitive behavioral theory have been successfully applied to the management of chronic pain, either delivered alone or as a component of an integrated, multimodal, and interdisciplinary pain management program.
CBT has been found to reduce pain and factors that go along with it such as depression, anxiety and distress. The goal is to educate you on how to change your thoughts and activities in a way that prevents or reduces pain flare ups.
Joint Supporting Splints
Osteoarthritic pain can often be reduced by joint supporting splints. Clinical studies have shown that wearing these type of braces can improve the ability to exercise. Both walking and confidence in exercise were improved by these types of devices. This may reduce the need for medications which pose side effect risks.
If you live with chronic pain then you may often feel tense and irritable due to the lack of relief. This can lead to more tension in the muscles and thus more pain. Finding ways to relax the muscle can be a great help in easing pain. Some of the most common relaxation methods include:
- Starting with slow, deep breathing in a place you will not be disturbed.
- Progressively relaxing muscle as the breathing continues.
- Imagining yourself in a state of comfort doing something enjoyable as you continue to breath.
Some people find getting a massage is a great place to practice this type of relaxation. You don’t have to go to the spa, many in home massage machines are available that are economically priced.
2. What Is A Good Substitute For NSAIDs?
NSAIDs are the most widely used Over The Counter (OTC) treatment for pain. The second most popular pain reliever sold OTC is acetaminophen. They are so popular, many would not be able to name another type drug used for pain outside of those two types of staple drugs.
Some people swear by one treatment and say another is not effective at all. Pain is not a one size fits all condition and while one medication works well for the majority it may not for you. Which is why it is important to have options.
Let’s take a deep dive look into the non NSAID OTC options that are available for treating pain.
What Can You Take If You Can’t Take Ibuprofen?
Salicylates are actually variations of NSAIDS. These are broken into five groups based on their chemical structure. If you don’t get relief from any one class then one of the drugs in the other NSAID class may help your pain. The table below lists the types of NSAIDs available.
|NSAID Class||Example Drugs|
|Non-acetylated salicylates||Diflunisal, salasalate|
|Propionic acids||Naproxen, Ibuprofen, diclofenac, indomethacin|
|Enolic acids||Meloxicam, piroxicam|
|Anthranilic acids||Meclofenamate, mefenamic acid|
Keep in mind that all of the different NSAID types listed above will have the side effects commonly associated with NSAIDs.
What Can I Take For Inflammation If Allergic to NSAIDs?
Acetaminophen is the generic form of Tylenol, in other countries may be called Paracetamol. It works to decrease pain and also reduces fever. Though not fully understood it is thought that acetaminophen blocks the formation of prostaglandins. This is the same way that NSAIDs provide relief from pain, however actetaminophen does not reduce swelling in the body. Therefore, researchers believe it blocks COX enzymes in the central nervous system and not in the rest of the body.
The American College of Rheumatology recommends acetaminophen as the first line treatment for osteoarthritis pain. It is frequently recommended over NSAIDs because it has lower risks for adverse effects on the stomach and kidneys.
It is important to remember however that acetaminophen in doses over 4 grams per day can be toxic to the liver. This amount is lowered to no more than 3 grams per day for patients over 65 years of age.
Key points for acetaminophen:
- If you drink alcohol the dose used should be lowered. Talk to your pharmacist to see what is best.
- Many medications contain acetaminophen! This includes both prescription and non-prescription. As many as 40% of acetaminophen overdoses are accidental. Read the labels and ask your pharmacist.
3. Topical Products Used for Pain
Many topical products are available to treat pain. If the pain is localized to just a few spots these products may provide a great alternative to NSAIDs. Subsequently, there are several different ways these products treat pain. Therefore, if one isn’t effective for you often another type should be.
All are absorbed through the skin to provide relief at the site. That is important because when taken by mouth being absorbed in the GI tract is where some of these products could cause side effects. These products come in a variety of forms such as:
The four main categories of topical pain relievers are described below.
These medications work by numbing the area that is painful. Consequently, they numb the skin by blocking signals the nerves in that area are sending back to the brain. This effect is reversible, meaning once the medicine wears off or is broken down the nerve sensation comes back.
Examples: lidocaine, benzocaine
Capsaicin comes from hot chili peppers and creates a burning like sensation when applied to the skin. After that, nerve cells are depleted of the chemical that allows the sensation of pain to be transmitted. This is why some people may notice an increased sensation when it is first applied followed by pain relief.
Example: capsaicin cream or ointment
Counterirritants do as the name implies they irritate the nerves in the pain area. As a result, this creates a hot or cold sensation that lasts for a short time after applying them. Ultimately, this heat or cooling also helps override the pain signals. This then provides a sense of pain relief.
Examples: menthol, camphor
Salicylates are the original drugs in a class known as non-steroidal anti-inflammatory drugs (NSAIDs). For example, the best known salicylate is aspirin. These work by inhibiting the COX enzyme that causes the formation of prostaglandins which causes inflammation as well as pain.
Examples: Voltaren gel, trolamine salicylate
The CDC recommends the use of topical pain relievers as first line treatments. This is because they can be safer than taking oral medications. This is especially important in people 75 and over due to side effect risks from taking oral medications.
Topical medications can be used to treat the following types of pain:
- Neuropathic pain
- Musculoskeletal pain
4. What Prescription Drugs Are Used For Pain?
Most people are now aware the U.S. has been in the mist of an opioid crisis. These potent prescription drugs used to treat pain have been widely abused leading to many deaths. The pendulum has swung so far that the CDC guidelines have recommended doctors use opioids much less often. In fact, many doctors now fear lawsuits or license termination if they prescribe these drugs too often.
Commonly used opioid medications include:
Prescription Drugs For Pain That Are Non Narcotic
There are many other types of prescription drugs your doctor may prescribe for pain that are not opioids. Some of those drug classes include anticonvulsants, antidepressants, topical medications and injectable drugs.
Commonly used examples of these types of medications include:
Is Tramadol An NSAID?
Tramadol is often confused by some patients as an over the counter drug similar to NSAIDs. However, it is a prescription medication that works in a completely different way to treat pain than NSAIDs do. Tramadol is thought to bind to receptors in the brain that transmit pain signals. However, it also blocks serotonin a neurotransmitter in the brain.
There is a smaller risk of addiction with Tramadol similar to other opioids. The upside of it is that it does not have side effects that are often seen with NSAIDs.
5. What Is The Strongest Natural Anti-Inflammatory?
Several natural anti-inflammatory chemicals exist. These can be found in foods or as dietary supplements. They may offer a safe and effective alternative treatment for chronic pain. Below are four with the most clinical study supporting their use.
Omega-3 Fatty Acids
Also known as fish oil these supplements contain the fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). They are found naturally in many type of fish and have been proven to reduce pain and inflammation. In fact the Arthritis Foundation recommends their use for arthritis pain.
Because inflammation has so many negative effects on our bodies fish oils have studies showing they are effective for heart disease, arthritis, lupus, psoriasis and many other inflammatory conditions.
This spice that is often used in Indian dishes is also a powerful anti-inflammatory compound. The active ingredient is curcumin. You can cook with it but higher doses are typically used for combating pain. It has been studied and found to decrease pain in the following conditions.
- Joint pain
In a study published by the Journal of Medicinal Food found 1,000mg of Turmeric per day to be as effective as ibuprofen or diclofenac. People who use it often report reduced pain, stiffness and inflammation.
Another fatty acid that can decrease diabetic nerve pain is alpha-lipoic acids. This compound is actually made by your body inside your mitochondria where energy for your cells is created. The pain reducing benefits come from the fact that this is a powerful antioxidant. That helps reduce inflammation which lowers the amount of pain you feel. It also improves nerve function, which can be the cause of pain for many people.
While the body does produce alpha-lipioic acid it may not be enough. That is why getting it from foods such as broccoli, tomatoes and spinach can be helpful. It is also sold in supplements that provide much larger doses.
Many plants contain the polyphenol compound known as reversatrol. Typically found in plant skins, these molecules acts as an antioxidant and anti-inflammatory in humans. It has been studied and shown to be efficacious at lowering pain levels when added on to the NSAID meloxicam.
It also lowers blood levels of several different markers of inflammation. To date is has been studied for osteoarthritis of the knee. More research is needed to confirm it works alone and for other types of pain.
6. What Pain Relievers Can I Take With NSAIDs?
Many people find they do not get relief from pain using just one pain reliever. Thus they often are left wondeirng if they can take more than one drug for pain. The answer is typically yes, but would depend on your specific health and conditions you may have. It is always best to ask your doctor before using multiple pain treatments.
In general, acetaminophen can be used with NSAIDS. This an be especially helpful for some people to rotate them to provide ongoing relief throughout the day. Make sure to check out 11 Most Important Tips on How to Alternate Tylenol and Motrin for more details on this.
Another effective strategy is to use some of the other non-drug options, topical preparations or natural remedies in addition to NSAIDs. Using multiple ways to deal with the pain is going to provide the most relief for the majority of people.
7. Overwhelmed With Options? You Need A Plan!
As you look for non NSAID pain reliever options there are many choices. However, to get the most effectiveness using various different options together is the best choice. This requires a pain management plan.
“Failure to plan is a plan to fail.”Ben Franklin
The plan should involve your doctor, pharmacist, nurses, dietician, physical therapist or possibly others. They should work together as the team with you as the quarterback. You maintain the blueprint that will help execute the plan. This is especially important if you have ongoing pain issues.
The plan should include the various different methods you will use to get the pain under control. It should also be shared with all the members of the pain management team. The plan will cover multiple ways of dealing with the pain. Most importantly the plan should help you deal with the emotional strain pain has on your day to day life.
The long term goal should be to change your lifestyle so that you eliminate the pain to the greatest extent possible. This will prevent despair and depression that can lead to a viscous downhill spiral ending in hopelessness.
Important components of the plan should include:
- Measuring the pain – there is now way to tell if your plan is working if you don’t measure.
- Evaluating your sleep – the body repairs itself during sleep, and it is a critical factor for ongoing pain.
- Show pain relievers & schedule – you need to know the drug, dose and schedule for the pain meds you are going to take.
- Isolates pain in certain areas – making sure to take advantage of pain in specific spots by using topical medications and devices when possible.
Putting all these things together into a plan with short courses of NSAIDs along with non-NSAID pain relievers can be quite effective. Pain doesn’t have to rule your life and treating it should be a top priority for you and your care team.
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Have you tried any non NSAID medications? Also, please share how it worked for you. Chime in below with your comments and thoughts.
Johnson, AG et al. The problems and pitfalls of NSAID therapy in the elderly. Drugs Aging. 1991: 130-143.
Zandra, Enis et al. Acetaminophen for Chronic Pain: A Systematic Review. Basic Clinical Pharmacology. 2015;118:184-189.