Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are widely used to treat pain and don’t require a prescription. But recent studies suggest that when taken regularly, these medicines can have serious side effects. They’ve been linked to kidney, bone, hearing and cardiovascular problems—including, most recently, an increased risk of heart attack.
For healthy people with occasional aches, there’s nothing wrong with taking an Advil or an Aleve to relieve discomfort, says Dr. Jyotsna Nagda, a pain specialist at Beth Israel Deaconess Medical Center. But “long-term use of anti-inflammatories is not a good idea,” she says, especially when alternatives are available.
Plus, says Alban Latremoliere, a pain physiologist at Boston Children’s Hospital, NSAIDs don’t always work well—which could prompt people to take higher and higher doses when they should be turning to other treatments. “Instead of looking for a pill that works for every type of pain, we need to be thinking about combination approaches that treat the underlying problems,” he says.
If you’re concerned about the level of pain medicine you’re taking, here are a few things you might try instead.
Acetaminophen or aspirin
Unlike ibuprofen, over-the-counter acetaminophen has not been linked to heart problems. Nagda recommends it to some of her patients—especially elderly ones—who aren’t good candidates for anti-inflammatory medicines.
Still, the drug is not without its own risks. “We recommend it on an as-needed basis, rather than an around-the-clock regimen,” says Nagda. “People should still be careful about the doses, and if they need it somewhat regularly, they should talk to their primary care physician about having their liver function tested.”
Aspirin is another option. While it is an NSAID, studies of regular aspirin use suggest a protective cardiovascular effect, rather than increased risks. (It can, however, cause stomach bleeding and ulcers.) “If someone has regular pain and they’re planning on doing something more strenuous than normal, I might tell them to take an extra-strength aspirin beforehand,” says Nagda.
Omega-3 fatty acids
For arthritis and related conditions, studies show that omega-3 fatty acids—found in fish, fish oil supplements, nuts and seeds—may help reduce pain and inflammation. The Arthritis Foundation recommends taking fish oil capsules with at least 30% omega-3s.
Latremoliere says that following a diet rich in fish, fruits, vegetables and whole grains may also ease pain throughout the body, although it won’t likely take the place of pain medicines entirely. “If you make a habit of avoiding foods that promote inflammation and eating foods that help reduce it, it can definitely be helpful,” he says.
Despite a recent review that called into question the benefits of curcumin—the active compound in turmeric—Nagda says that people seeking pain relief may still want to try adding the yellow spice to their diet.
“It has anti-inflammatory properties, and there are some small studies that show benefits for patients with rheumatoid and other forms of arthritis,” she says. It’s safe in quantities used in cooking and flavoring food, so as long as you don’t mind the taste, there’s little downside.
This traditional Chinese medicine technique may help reduce pain associated with back pain, neck pain, arthritis, headaches, fibromyalgia pain after surgery, according to research. Not everyone who tries acupuncture improves, says Nagda, but “when you look at risks and benefits compared to other methods like NSAIDs, acupuncture comes out on top with minimal risks.”
While acupuncture’s cost can be prohibitive for many pain sufferers, it is increasingly covered by health insurance—at least in part—as its benefits become clearer. Massage is another approach that's been shown to to relieve chronic lower back pain.
Exercise and mindful movement
Regular exercise is a good way to ward off chronic pain and to reduce symptoms if it does develop. But certain types of movement may be more beneficial than others.
Tai chi has been shown to benefit people with fibromyalgia, for example, and yoga may help with back pain and arthritis. “Even if these techniques don’t necessarily decrease pain, they may help people cope with it better,” says Nagda.
Nagda also recommends swimming to many of her pain patients, as a way to stay active and flexible without stressing their joints. And for injuries, she stresses the value of using heat and ice and seeing a physical therapist, rather than masking pain with a pill.
In one 2016 study, people who practiced seated meditation for 20 minutes a day had less reaction to a painful stimulus than those who sat and read a book. The research didn’t include people with chronic pain, but the authors say meditation could have potential as an alternative to painkillers like opioid drugs. Other research has shown that mindfulness can reduce a person's experience of physical pain (and emotional pain, too).
“If you meditate, you’re helping your brain relax and get into a state where some of its regions can be slowed down,” says Latremoliere. “That might help reduce focus on pain or attention to stimuli, so it makes sense that it might help people feel better.”
More sleep (or coffee, in a pinch)
Latremoliere’s own research in mice, published recently in Nature Medicine, has shown that chronic sleep deprivation can enhance pain sensitivity—and that a dose of caffeine can temporarily reverse those effects. Studies in humans have also suggested that staying awake for long periods of time can lower people’s thresholds for pain, and that the equivalent of a few cups of coffee before a workout can reduce perceived muscle pain.
“Our research suggests that if you have chronic pain and you’re not sleeping enough, your pain is probably greater because of that,” says Latremoliere. People should be wary of relying on caffeine to get by, however. “Coffee in the morning might help reduce pain and get you through the day,” he says, “but if you have it too late in the day it could make your sleep, and your pain, even worse.”