Other drug products can help against some of the pains treated by NSAIDs. Alternatives can also be nondrug, too.
Decisions may be easier for short-term problems than for long-standing ones. For chronic pain, it is important to consult a doctor or pharmacist about medications. The choices in considering pain drugs may be summed up as whether to take:
- An NSAID
- An alternative drug option
- A nondrug option, which could be an alternative to medical pain treatment or something to go with it
- Nothing at all
Looking at the labels is one of the best ways to evaluate a medication likely to be best for an individual pain need. Labels also show warnings about when not to choose a particular drug. Pharmacists are an important aid to these decisions.
Doctors also have important advice on options, especially if the choice of pain treatment requires a prescription. They can prescribe more powerful drugs when needed.
It is not practical to list all the potential concerns for every decision about the NSAID drugs available over-the-counter or on prescription and their alternatives.
Contents of this article:
NSAID alternatives for headache
With the example of headache, NSAIDs are available over the counter in both pharmacies and regular stores. These are relatively safe drugs packaged at lower dosages.
NSAIDs like ibuprofen are an option for the headache alongside the option of acetaminophen.
The NSAID might be preferred because the headache is accompanied by symptoms such as those of a cold, when there are other aches and pains, or a temperature that accompanies the headache. Another example may be when a headache occurs alongside period pain. Labels give important information and can help with the decision, as can pharmacy professionals.
Further questions can arise beyond the initial choice of drug, especially after the short-term treatment period:
Some types of headache such as chronic daily headache need medical treatment.
- When does the headache become something experienced too often?
- Is it something a doctor should check is not a chronic problem or has another condition underlying it?
- What are the side effects of drugs, and is there any potential for long-term drug safety risks?
- Is the problem with headache one that non-medical treatments could help to avoid, reduce, or treat?
Chronic daily headache (CDH) - a problem affecting people who get a headache on more days than not is just one example of a headache complaint that would need medical attention. Doctors define CDH as more than 15 daily headaches a month for 3 months or longer.
There is a range of possible explanations behind CDH that need the help of doctors and sometimes nerve specialists.
Problems leading to CDH can include tension-type headaches or migraine, and these can be made worse when more frequent and persistent headaches actually become associated with too much medication.
Painkillers used to treat the headache, whether they be NSAIDs or other drugs, can go on to become part of the problem.
In such a case, the new and worsened complaints are known as "medication overuse headaches" - also called rebound headaches.
The management options for CDH can include relaxation techniques and cognitive behavioral therapy in addition to drug changes and even cutting out medications from the pharmacy altogether. These alternatives to NSAIDs depend on the individual.
Scientists, whose paper was published in the journal Experimental Brain Research in January 2016, had used a wireless device to deliver electrical stimulation to a deep brain structure usually associated with reward and drug abuse. They said this may be a nondrug way to treat pain, by addressing pain sensation and perception pathways in the brain.
While this study, published in the journal Alternative and Complementary Therapies in December 2015, had the serious limitations of lacking a control group and randomization to account for any placebo effect or other bias, it found an association with acupuncture for reduced pain symptoms in children with chronic pain conditions.
This study, published in the Journal of Neuroscience in November 2015, compared mindfulness meditation with drug treatment for pain (using an opioid drug, so not a comparison with NSAID analgesia).
NSAID alternatives for lower back pain
Lower back pain is a classic example in which NSAIDs are available for symptom relief. They are particularly convenient for new or short-term problems. But questions about drug and nondrug choices become especially relevant when back complaints become long-term.
Some cases of long-term lower back pain might benefit from interventions aimed at changing aspects of work, for example:
One area of intervention is to start making changes that reduce workplace inactivity and the seating strains that can be placed on the back.
- Adapting parts the workplace, such as desks and chairs
- Job task adjustments
- Changes to working hours
Cognitive behavioral therapy (CBT), including individual and group sessions, can also help with "back skills training." This can prevent painful lower back problems from becoming worse and leading to unnecessary disability and further routine damage.
The CBT approach for back pain is to address the way health behaviors and beliefs can often continue a long-term and painful problem. The approach aims to help with factors such as:
- Too little physical activity
- Too much activity
- Making the pain seem worse than it is
- Avoidance behaviors - not doing things that may actually help, due to fear of pain
Various healthcare professionals can assist, including psychologists, occupational therapists, nurses, and physical therapists.
Identifying and changing negative thoughts around problems with back pain is part of the psychological help of CBT. There can also be education for back pain, and help to develop skills such as:
- Doing graded activity
- Pacing things
- Techniques for relaxation
Pain management plans and 'stepped care' approaches
A multipronged approach that steps up the treatment options can be recommended by doctors and pain specialists difficult pain conditions that become long-term. Expert bodies behind such recommendations include the International Association for the Study of Pain (IASP) and the British Pain Society (BPS).
Treatment for long-term pain may require a treatment plan that steps up over time.
Stepped care for long-term pain includes dealing with the "biopsychosocial" domains. Such an approach is recommended in BPS guidelines, for example. As with the back pain interventions mentioned above, other healthcare professionals can come in. However, doctors are at the center of helping to manage the problems.
The idea of this approach to management is that it takes account of the different layers of a patient's experience of long-term pain and their response to it. It is suggested for problems lasting longer than 3 months, not including cancer pain.
A similar approach gives an outline of "measurement-based step care solutions" in a paper published in an IASP journal.
This paper cites the Loeser's model of chronic pain. This model says that the distress of conditions such as long-term lower back pain comprises three elements beyond the actual stimulation of pain nerves:
- Pain behavior
The stepped care approach offers a number of steps that doctors might take to address these elements of chronic pain. These steps can be taken in diagnosis as well for management. The approach can include:
- Measuring the pain - using ratings questions along two scales, one for intensity and another for the level of interference with quality of life
- Measuring the mood - using assessments of psychological distress, anxiety, depression, and screening for problems such as PTSD
- Assessing the effect of pain on sleep - for chronic pain treated with opioids, these drugs have been associated themselves with disorders such as sleep apnea, so there may also be assessment for this
- Assessment and management of risks, including medication risks