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NSAIDs for Fibromyalgia & Chronic Fatigue Syndrome

Antiinflammatories: Risks & Considerations

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Updated March 16, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

When you have fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS), you can end up taking a lot of different medications, including painkillers. While that may help you feel and function better, it can also be dangerous. It pays to really understand the drugs that are available to you.

Several types of painkillers are available over the counter (OTC), and a large percentage of us are given prescription painkillers at some point in our illness. These drugs each have their own dangers and possible side effects, and some can interact badly with other medications.

One of the most common types of painkillers is anti-inflammatory drugs. One commonly used type of anti-inflamatories is called NSAIDs, which stands for non-steroidal anti-inflammatory drugs. Popular OTC NSAIDs include:

  • Ibuprofen (Advil, Motrin)
  • Naproxen (Aleve, Naprosyn)
  • Aspirin (Bayer, Bufferin, Excedrin)

These drugs are also available in prescriptions strengths. Prescription-only NSAIDs include:

  • Nabumetone (Relafen)
  • Piroxicam (Feldene)
  • Ketoprofen (Orudis)
  • Diclofenac (Voltaren)
  • Etodolac (Lodine)
  • Celecoxib (Celebrex)

Most of us are familiar with the use of NSAIDs to reduce pain caused by inflammation. However, some NSAIDs may alleviate pain in another way as well. They alter your perception of pain by blocking some enzymes that are part of your body's response to painful stimuli. It's not clear whether this mechanism is effective against the unusual pain types associated with FMS.

Some studies suggest inflammation in ME/CFS. FMS is generally considered not to involve inflammation, but at least one study suggests inflammation of the fascia. Many people take NSAIDs for FMS and ME/CFS-related pain, and some also take NSAIDs for other medical problems that involve inflammation.

NSAID Risks

According to the American Journal of Medicine, more than 100,000 people are hospitalized due to NSAIDs each year in the U.S., 15,000-20,000 die each year from NSAID-related problems such as ulcers and gastrointestinal bleeding, and as many as 60% of NSAID users may develop digestive side effects.

NSAIDs are also linked to an increased risk of dying from heart attack or stroke. These drugs can also lead to liver or kidney problems.

Taking 2 NSAIDs together is dangerous – a 2004 study published in the European Journal of clinical Pharacology showed that it increased the risk of liver injury or kidney failure by 500-600% over the use of a single NSAID.

Long-term use, such as you'd expect with a chronic condition, may increase these risks.

Some of the problems stemming from NSAID use may be due to people's attitudes toward OTC drugs – they may think they're not important or dangerous and therefore don't report use to their doctor or pharmacist. It's crucial that these health professionals know everything you're taking, including OTC drugs and dietary supplements, so they can help you avoid serious side effects and interactions.

NSAID Side Effects & Interactions

In addition to the above risks, NSAIDs can cause several side effects. The most common ones are:

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Decreases in appetite
  • Rash
  • Dizziness
  • Headache
  • Drowsiness

Some of these side effects (digestive problems, dizziness, headache, drowsiness) are also common symptoms of FMS and ME/CFS. When you start taking a new NSAID, it's important to note any changes in how you feel that may be due to the medication.

NSAIDs can interact negatively with several other drugs.

Because NSAIDs reduce your blood's ability to clot, it can be dangerous to combine them with anticoagulants (blood thinners) such as Coumadin (warfarin).

If you're being treated for hypertension (high blood pressure), you need to know that NSAIDs may make your medication less effective.

Interactions and side effects may vary by drug. To look up side effects of specific NSAIDs, go to About.com's Drugs A-Z.

Reducing Your Risk

According to the FDA, to protect your health you should only use NSAIDs exactly as prescribed, at the lowest possible dose, and for as short a time as you can.

When your pain is chronic, that last recommendation is difficult to follow. Be sure to report any increase in side effects to your doctor. Your doctor may want to monitor markers of liver health if you're taking NSAIDs long term.

Smoking cigarettes and drinking alcohol can increase your risk of NSAID-related ulcers or bleeding problems – both of which can cause strike without warning and may cause death. Be sure your doctor knows about your smoking and alcohol use.

Are NSAIDs Right for You?

You and your doctor should decide together whether NSAIDs are appropriate for you, based on your diagnoses, symptoms, overall health and lifestyle factors. It's important to note that one NSAID may work better for you than others, so it may take experimentation with different drugs to achieve the best results.

If you don't feel NSAIDs are effective at reducing your pain, talk to your doctor about possible alternatives and weigh the risk against the benefits.

Sources:

American College of Gastroenterology. All rights reserved. Aspirin and NSAIDS.

Carruthers BM, et. al. Journal of internal medicine. 2011 Oct;270(4):327-38. doi: 10.1111/j.1365-2796.2011.02428.x. Myalgic encephalomyelitis: International consensus Criteria.

Clinard F, et. al. European journal of clinical pharmacology. 2004 Jun;60(4):279-83. Association between concomitant use of several systemic NSAIDs and an excess risk of adverse drug reaction. A case/non-case study from the French Pharmacovigilance system database.

Kovac SH, et. al. Arthritis and rheumatism. 2008 Feb 15;59(2):227-33. Association of health-related quality of life with dual use of prescription and over-the-counter nonsteroidal anti-inflammatory drugs.

Liptan GL. Journal of bodywork and movement therapies. 2010 Jan;14(1):3-12. Fascia: a missing link in our understanding of the pathology of fibromyalgia.

Maes M, et. al. Journal of affective disorders. 2012 Feb;136(3):933-9. Evidence for inflammation and activation of cell-mediated immunity in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): Increased interleukin-1, tumor necrosis factor-alpha, PMN-elastase, lysozyme and neopterin.

The Merck Manual Home Health Handbook. All rights reserved. Treatment of Pain.

Singh G. American journal of medicine. 1998 Jul 27;105(1B):31S-38S. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy."

U.S. Food and Drug Administration. Medication Guide for non-Steroidal anti-Inflammatory Drugs (NSAIDs). Accessed February 2012.

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