NSAIDs Versus Opioids for Pain Relief: The Key Differences

The controversy surrounding opioid use has drastically reduced prescriptions of this painkiller, but are NSAIDs good enough to fill the gap?

Illustration by The Epoch Times, Shutterstock

In the high-stakes arena of pain management, tensions are flaring over go-to analgesics. As the opioid epidemic continues to rage, these addictive pain meds have fallen out of favor. But are alternatives such as nonsteroidal anti-inflammatory drugs (NSAIDs) the remedy for chronic pain?

The answer is complicated at best—and it may vary from person to person, according to experts.

Big Differences in How Each Drug Class Works

While both of these medication classes are commonly prescribed, they differ significantly in safety, potential risks, effectiveness at pain relief, and appropriate use.

Safety

NSAIDs such as ibuprofen, naproxen, and aspirin are generally considered the safer choice, available over the counter in lower doses. However, long-term use risks gastrointestinal issues, kidney problems, and complications for those with preexisting conditions.

Opioids, which include codeine, oxycodone, and morphine, have higher risks overall—they’re controlled substances with the potential for dependence and addiction. Improper or extended use further increases the chances of adverse effects.

Health Risks

Both NSAIDs and opioids carry health risks.

NSAIDs can interact with other medications such as blood thinners and some antidepressants. They may also increase blood pressure, particularly for individuals with already elevated levels. Additionally, those with a history of asthma may be at higher risk of complications.

The greater danger of opioids lies in their addiction and misuse potential. Their potent pain relief can readily lead to physical and psychological dependency. Over time, people may need higher and higher doses to achieve the same pain relief—perpetuating a hazardous cycle of dose escalation.

Pain Relief Effect

NSAIDs and opioids have distinct pain relief mechanisms.

Generally, NSAIDs effectively reduce inflammation and relieve mild to moderate pain. But they may not relieve severe or neuropathic pain well.

Opioids potently block pain signals, making them highly effective at managing severe pain from cancer, fractures, surgery, or nerve damage.

It’s worth noting that individual responses to pain medications can vary. The most suitable option depends on a personalized evaluation of each person’s unique pain profile and needs.

When Is Either More Appropriate?

When choosing between NSAIDs or opioids, there’s no universal best option, according to Dr. Kevin Zacharoff, faculty member, clinical instructor, and course director of Pain and Addiction at the Renaissance School of Medicine at Stony Brook University.

The most appropriate medication depends on the individual patient.

For an otherwise healthy patient, NSAIDs may have a better safety profile, Dr. Zacharoff told The Epoch Times. But for chronic pain, chronic use of NSAIDs diminishes this advantage.

“So for the long run, from purely a safety perspective, opioids might be better,” he said.

The choice further depends on pain severity, type, patient risks, and individual factors.

“NSAIDs are typically the first-line treatment for mild to moderate pain due to their safety profile, ease of access, and effectiveness for most common pain conditions,” Dr. Zacharoff said.

Opioids, because of their potential risks and addictive properties, are usually reserved for severe pain, acute injuries, post-surgical recovery, or severe chronic pain that hasn’t responded to other treatments, he said. But there are exceptions.

“In some cases, a combination of both medications may be used cautiously and under close medical supervision,” Dr. Zacharoff said. This approach can enable lowering opioid doses while maintaining pain control.

For minor pain, the likelihood is that NSAIDs will be just as effective as opioids, he said.

Confusion Around Pain Treatment Guidelines: Expert

Dr. Zacharoff said he believes that we’re in a confused state regarding pain treatment, and the push to reduce opioids may actually be worsening pain relief outcomes.

“We’re starting to see a lot more in the scientific literature about this, and it’s a very large problem for a certain percentage of patients,” he said.

Dr. Zacharoff cautions against perceiving NSAIDs as universally safer alternatives. For many older adults, those with hypertension or coronary artery disease, NSAID use is often contraindicated because of risks.

“I think that people don’t realize that NSAIDs and acetaminophen—which is not an NSAID, by the way—carry their own level of risk,” he said. “Whether we like it or not, every treatment option carries risk.”

Ultimately, while NSAIDs and opioids are both effective for pain relief, they do differ in terms of safety, potential risks, and appropriate uses. It’s crucial to consult with a health care professional to determine the most appropriate pain management approach based on your individual needs and circumstances.