NSAIDs – Does GI Bleeding
Beg Natural Alternatives?

NSAIDs-if you take them regularly or exceed recommended label dosages--beware! You may become one of 100,000 hospitalizations and 17,000 deaths in the U.S. annually from serious gastrointestinal (GI) side effects.1

The widespread use and accessibility of nonsteroidal anti-inflammatory drugs (NSAIDs) may allow consumers to erroneously assume the safety of these medications. This problem is largely a consequence of NSAIDs' regular use by more than 60 million Americans (2) resulting in clinically significant upper GI events in 1–2% (up to 1,200,000) of users (3).

Not widely appreciated, however, is that NSAIDs use also results in death. If deaths from GI toxic effects from NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain mainly a "silent epidemic," with many physicians and most patients unaware of the magnitude of the problem. Furthermore the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDS.4

Non-steroidal anti-inflammatory drugs (more commonly known as NSAIDs) are the medications 14 million patients take regularly for arthritis -- up to 60% of whom will experience gastrointestinal side effects as a result.5

That most people who are hospitalized with GI issues have no warning signs that NSAIDs are causing them serious internal damage. One 1997 study showed that "81% of the patients who were hospitalized with a serious GI complication did not have any prior GI adverse event. This finding has important clinical and health policy implications. Since most patients who have a hospitalization do not have a prior GI side effect and most patients who have a side effect are not subsequently hospitalized, a clinician cannot depend on early GI symptoms to identify patients at risk or provide a warning for subsequent serious complications.” 6

Millions of others take these drugs every day for pain and symptoms ranging from acute injury to menstrual cramps.

A NSAID is safest when taken in low doses for brief periods. NSAIDs side effects occur most frequently in people taking large doses over a prolonged period.

Drug side effects are also a problem for all pharmaceuticals.

Study: 44 percent of Americans use NSAIDs incorrectly

Forty-four percent of Americans said they took more than the recommended dose of NSAID pain relievers in 2003, up from 26 percent in 1997, according to a study release May 21, 2004 by the American Gastroenterological Association at Digestive Disease Week, 2004 in New Orleans, LA.7 Study Researchers compared findings of two consumer surveys—one conducted in 1997 and another in 2003—to measure consumer awareness levels of side effects associated with over-the-counter analgesics.

The comparison study found that 59 percent of respondents were concerned about side effects in 2003, up from only 18 percent in 1997.

The study concluded that despite increasing evidence of the serious side effects associated with indiscriminate use of store-bought NSAIDs, U.S. adults continue to use the medications incorrectly, putting themselves at risk for life-threatening side effects.

There’s usually no warning signs from life-threatening NSAID side effects

"Because these drugs are easily accessible and can be very effective, there is a misperception out there that they have no risks," said Byron Cryer, M.D., lead investigator on the study and an associate professor of medicine at the University of Texas Southwestern Medical School in Dallas, Texas. "In reality, there are serious side effects associated with inappropriate use that patients need to recognize."

"There is no medical test to determine who will develop side effects, and there usually are no warning signs. Education is imperative to help patients recognize the risk factors and have discussions with their physicians," said Cryer.

NSAIDs, including the pain medications aspirin, ibuprofen and naproxen, are one of the leading causes of stomach ulcers and have been associated with side effects ranging from stomach upset to stomach bleeding, which can be life threatening.

Relationship between NSAIDs and arthritis

Doctors often prescribe higher doses of NSAIDs for rheumatoid arthritis sufferers because the condition leads to a significant degree of heat, swelling, and stiffness in the joints.

Early, aggressive treatment is important for rheumatoid arthritis sufferers in order to prevent further damage. Lower doses are typically adequate for osteoarthritis and muscle injuries, since there is less swelling and no warmth in the joints.

Painkiller drug manufacturers revised their labels to include more information on potential heart attack and stomach bleeding risks associated with NSAID use.

How do NSAIDS work?

Most drugs are consumed for the common purpose of pain relief, and they often live up to their promise by dulling what seems to be unbearable pain.

NSAIDs are non-steroidal. Steroid medications attack attack more than pain, they suppress the immune system--the body's natural healing response to illness or trauma.

Instead NSAID drugs mainly inhibit the body's ability to synthesize prostaglandins, a family of chemicals that are produced by the cells of the body and have several important functions. They promote inflammation, pain, and fever; support the blood clotting function of platelets; and protect the lining of the stomach from the damaging effects of acid.

Prostaglandins are produced within the body's cells by the enzyme cyclooxygenase (COX). There are two COX enzymes, COX-1 and COX-2. NSAIDs block the COX enzymes and reduce prostaglandins throughout the body. As a consequence, ongoing inflammation, pain, and fever are reduced.

Since the prostaglandins that protect the stomach and support platelets and blood clotting also are reduced, NSAIDs can cause ulcers in the stomach and promote bleeding.

NSAIDs are commonly used to treat a variety of conditions capable of causing inflammation, one of which includes the symptoms of arthritis (joint swelling, stiffness and pain). People suffering from arthritis have typically taken NSAIDs at one time or another.

What NSAIDS are approved in the United States?

Non-steroidal anti-inflammatory drugs comprise a large class of drugs with many options. In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) and prescription brands of NSAIDs.

The four types of NSAIDs most commonly used to treat many types of back pain, neck pain, knee pain, osteoarthritis and rheumatoid arthritis include:

  • Aspirin(e.g. brand names Bayer, Bufferin, St. Joseph, Zorpin)

  • Ibuprofen (e.g. brand names Advil, Motrin, Nuprin, Genpril, Ibu-200, Midol),

  • Naproxen(e.g. brand names Aleve, Naprosyn)

  • Celecoxib (COX-2) inhibitors (e.g. brand name Celebrex)

The type of NSAID recommended usually depends on the patient’s diagnosis, clinical situation, level of pain, individual risk factors, and past experience with particular medications.

The complete list of approved NSAIDs is very long. The following list contains only the most commonly used:

  • Aspirin (Bayer, Bufferin)
  • Salsalate (Amigesic)
  • Diflunisal (Dolobid)
  • Ibuprofen (Motrin, Advil)
  • Ketoprofen (Orudis)
  • Nabumetone (Relafen)
  • Piroxicam (Feldene)
  • Naproxen (Aleve, Naprosyn)
  • Diclofenac (Voltaren)
  • Indomethacin (Indocin)
  • Sulindac (Clinoril)
  • Tolmetin (Tolectin)
  • Etodolac (Lodine)
  • Ketorolac (Toradol)
  • Oxaprozin (Daypro)
  • Celecoxib (Celebrex)

What are the side effects of NSAIDs?

NSAIDs are associated with a number of side effects. The frequency of side effects varies between the drugs. The most common side effects are:

  • Kidney failure
  • Liver failure
  • Ulcers
  • Bleeding
  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Appetite loss
  • Rash
  • Dizziness
  • Headache
  • Drowsiness
  • Edema
  • Allergic reaction

What about acetaminophen?

Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers). It's not a non-steroidal anti-inflammatory drug but is often referenced as one under the NSAID umbrella by consumers and medical community alike. Acetaminophen relieves pain by elevating the pain threshold, that is, by requiring a greater amount of pain to develop before a person feels it. It reduces fever through its action on the heat regulating center of the brain.

Although acetaminophen is not as likely to cause stomach damage as aspirin, it is characterized by its own harmful effects. Larges doses of acetaminophen may cause severe liver damage and death.

If used as an over-the-counter arthritis treatment by unsuspecting consumers, acetaminophen numbs pain but does not help stiffness or inflammation. Many people, however, admit to consuming acetaminophen for this purpose.

Even though it is sold over-the-counter, acetaminophen can be toxic if label dosage warnings are not followed after prolonged use. A recent study showed that acetaminophen-induced liver toxicity accounts for more than 40% of US cases of acute liver failure.

Two acetaminophen brand names are Tylenol and Anacin-3 Maximum Strength.

To avoid NSAIDs side effects, choose natural supplements instead

If you could achieve the relief you need safely, without total reliance on drugs, wouldn’t it be worth a try?

For centuries, nature has contained the answers for pain relief. There are many botanical and herbal substances that have proven effective and safe.

Here are three trusted natural products that may be helpful in attaining back pain and joint pain relief from injury, surgery or arthritis:

  1. Pain Relief Complex: Dietary supplement caplets consisting of patent-pending safflower extract and clinically-proven boswellia extract contains no aspirin and is gentle on the stomach. Use as a complement or potential replacement to existing NSAIDs as it’s a natural anti-inflammatory with no GI bleeding and minimal side effects.

  2. New Advanced Joint Health Complex: Contains natural, fast-acting key joint nutrients to help bring joint comfort and mobility. Two coated caplets daily help build cartilage to promote joint health and flexibility, consisting of glucosamine hydrochloride and clinically-proven patent-pending boswellia extract for faster relief in as few as five days.

  3. Joint & Muscle Pain Cream: A natural blend of plant extracts with pain-relieving, cooling menthol that provides temporary but a very deep pain relief rub and for minor pain associated with arthritis, bruises, muscle strains and sprains. This product alone may reduce your dependency on NSAID dosage as its relief is immediate and lasts up to four hours.

For complete background information and our personal testimonies on each, click on the following link: Three natural pain products.


1. Edward J. Frech and Mae F. Go, "Treatment and chemoprevention of NSAID-associated gastrointestinal complications", Therapeutics and Clinical Risk Management, 2009, pp. 65-73

2. Dai, C, Stafford, RS, Alexander, GC. National trends in cyclooxygenase-2 inhibitor use since market release: Nonselective diffusion of a selectively cost-effective innovation. Arch Intern Med 2005;165: 171–177.

3. Silverstein, FE, Faich, G, Goldstein, JL, et al. Gastrointestinal toxicity with celecoxib vs. Nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: The CLASS study: A randomized controlled trial. Celecoxib long-term arthritis safety study. JAMA 2000;284: 1247–1255.

4. Wolfe M. MD, Lichtenstein D. MD, and Singh Gurkirpal, MD, "Gastrointestinal Toxicity of Nonsteroidal Anti-inflammatory Drugs", The New England Journal of Medicine, June 17, 1999, Vol. 340, No. 24, pp. 1888-1889

5. Understanding GI Bleeding (ACG), a consumer education brochure, The American College of Gastroenterology. http://www.acg.gi.org/patients/gibleeding/index.asp

6 Singh Gurkirpal, MD, Ramey Dena, Morfeld Dianne, Shi Hong, MS, Hatoum Hind, PhD, and Fries James, MD, “Gastrointestinal Tract Complications of Nonsteroidal Anti-inflamatory Drug Treatment in Rheumatoid Arthritis”, Archives of Internal Medicine, July 22, 1996, Vol. 156, pp. 1530-1536

7. American Gastroenterology Association public release dated May 21, 2004. http://www.eurekalert.org/pub_releases/2004-05/aga-cap051904.php

Health statements on this page have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease

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