Taking anti-inflammatories every day: why it's not a good idea

Non-steroidal anti-inflammatory drugs (NSAIDs) — ibuprofen, diclofenac, naproxen, indomethacin, meloxicam, ketoprofen, ketorolac, and many others — are medications almost everyone knows. They're available over the counter, they're inexpensive, and for many kinds of acute pain they work very well. The problem starts when a pain that used to be occasional becomes daily, and the patient's habit (often shaped by health professionals too) turns into: "I take an anti-inflammatory every day because it helps me."

Every day in my office I see patients who arrive having taken anti-inflammatories for months, sometimes years — on their own initiative, or on an old prescription no one ever went back to review. The phrase I hear most is 'I just take one when it hurts, it's nothing.' The problem is that when that 'when it hurts' becomes a daily routine, we're no longer talking about an occasional pain reliever — we're talking about a long-term drug with concrete risks. And those risks give no warning: they show up once the damage is already done.

Let me explain why long-term use of anti-inflammatories is not a good idea, what the risks are, and what alternatives exist when the pain won't go away.

Why they stop working well for chronic pain

Anti-inflammatories work by inhibiting enzymes (the COX enzymes) involved in the body's inflammatory and pain processes. When an acute injury produces local inflammation — a sprain, an acute muscle spasm, a recent tendinitis — these medications are very useful because they target the pain mechanism directly.

But chronic pain is a different story. When pain persists for months, the mechanisms sustaining it change:

• Inflammation is no longer the main component.
• Processes of central sensitization appear: the nervous system amplifies pain signals.
• There are changes in the pain pathways, both peripherally and in the central nervous system.
• Sometimes neuropathic components are added (pain from injury to the nerve itself), which anti-inflammatories don't touch.

That's why what worked at first stops working. And when a patient keeps raising the dose or trying ever-stronger anti-inflammatories, the result is usually the same: little improvement in pain, more side effects.

One nuance I always insist on explaining: NSAIDs are not harmless just because they're sold without a prescription. The stomach damage, the decline in kidney function and the increased cardiovascular risk have been described for decades, and they depend on both dose and duration. Nor are all NSAIDs the same: the safety profile varies quite a bit between molecules. What I see is that the average patient combines two or three commercial brands without knowing they all contain the same active ingredient, and ends up on a much higher cumulative dose than they think they're taking.

The risks of long-term use

This is the least known and most underestimated part. Prolonged use of anti-inflammatories carries concrete, well-documented risks:

Gastrointestinal risk

This is the best known. Anti-inflammatories can cause:

• Gastritis and dyspepsia.
• Gastric and duodenal ulcers.
• Upper gastrointestinal bleeding (sometimes without prior symptoms).
• Perforation of a hollow organ (rare but serious).

The risk rises significantly in patients over 65, in those taking corticosteroids or anticoagulants, and in those with a history of ulcers.

Kidney risk

Anti-inflammatories reduce blood flow to the kidneys. With prolonged use they can:

• Worsen pre-existing kidney disease (sometimes without the patient knowing they have it).
• Cause analgesic nephropathy.
• Cause sodium and water retention, aggravating high blood pressure or heart failure.

Cardiovascular risk

The evidence is consistent: prolonged use of most NSAIDs (with partial exceptions such as naproxen) increases the risk of heart attack, stroke and cardiovascular events. The risk is higher in patients with pre-existing cardiovascular risk factors, but it is present even in healthy people.

High blood pressure

NSAIDs raise blood pressure and can interfere with the effect of blood pressure medications.

Liver toxicity

Less frequent but well described, especially with certain specific NSAIDs and with prolonged use.

Drug interactions

With anticoagulants (increasing the risk of bleeding), blood pressure medications (reducing their effect), lithium and methotrexate, among others.

What to do when the pain won't go away

The way out is not to keep taking anti-inflammatories every day. It's to rethink how the chronic pain is being managed, from a broader perspective. The alternatives include:

Medication designed for chronic pain

There are drugs designed specifically for chronic pain that are not anti-inflammatories:

• Gabapentinoids (gabapentin, pregabalin): very effective for neuropathic pain.
• Low-dose antidepressants (amitriptyline, duloxetine): they have a pain-relieving action independent of their antidepressant effect.
• Tramadol or other centrally acting analgesics in selected cases, with careful monitoring.
• Acetaminophen (paracetamol) at appropriate doses: although it is not a true anti-inflammatory, it can be part of a pain treatment plan with a better safety profile.

Interventional treatments

Nerve blocks, joint injections, radiofrequency ablation, regenerative medicine: techniques that deliver medication directly to the site of the pain without affecting the whole body. They have a much better safety profile than long-term oral medication.

Non-drug treatments

Targeted physical therapy, postural re-education, appropriate physical activity, weight management, relaxation techniques. They sound less "powerful," but they are the foundation of any successful approach to chronic pain.

A comprehensive approach

Chronic pain responds better to a strategy that combines several tools than to a single, stronger medication.

When anti-inflammatories are the right choice

It's not that anti-inflammatories "are bad." They have their place:

• For acute pain (recent injuries, muscle spasms, post-surgical pain), for short periods (days to a few weeks).
• For flare-ups of chronic conditions, in defined, limited courses.
• Under medical supervision in patients at low risk of complications.

What I don't recommend is sustained daily use for months or years, especially without periodic medical evaluation. And even less as a substitute for actually treating the underlying problem causing the pain.

My approach when someone arrives taking NSAIDs every day is always the same: first understand why they're taking them, because it's almost never the right answer to the pain they have. If it's neuropathic pain, the anti-inflammatory does practically nothing for them; if it's chronic myofascial or joint pain, there are far safer and more effective alternatives. I prescribe NSAIDs when there's a clear inflammatory component, and for short, well-defined periods. If I need a baseline analgesic, I'd rather go a different route than leave a patient self-medicating for months.

A question to ask yourself

If you've been taking anti-inflammatories every day for weeks or months, ask yourself this: are they really controlling my pain, or just masking it a little while I build up potential complications? If the answer is the second (which is usually the more common one), it's time to bring the problem to a different kind of consultation.

Chronic pain isn't solved with more painkillers. It's solved by understanding what's causing it and putting together a comprehensive plan. And the first rule of that plan is usually: stop taking anti-inflammatories every day.

What defines long-term success in these cases isn't having found the perfect painkiller — it's no longer needing one every day. When a patient comes back at six months and tells me the little box is no longer on their nightstand, I know we figured out together where the pain was coming from and which tools actually work to control it. My role isn't to swap one anti-inflammatory for another drug, but to offer a plan that combines targeted treatment, physical therapy and, when appropriate, image-guided procedures that make it possible to reduce medication without losing quality of life.