Are NSAIDS Still Off Limits for People with IBD?

For years, ibuprofen and other types of nonsteroidal anti-inflammatory medications have been considered too damaging to the gut for people with IBD. But new research suggests they might be OK in some circumstances.

If you live with inflammatory bowel disease (IBD), you’re still subject to the same fevers, aches, and pains as everybody else. You may even have other inflammatory conditions that require ongoing relief from pain and swelling.

But because people with Crohn’s disease and ulcerative colitis have long been warned against taking certain medications, you may feel overwhelmed when trying to find an over-the-counter medication that’s safe for you.

In general, your options can be divided into two kinds of medicines:

• acetaminophen (the most common brand name in the United States is Tylenol)
• nonsteroidal anti-inflammatory drugs (NSAIDs), which include:
  • ibuprofen (Advil and Motrin)
  • aspirin (Bayer, Excedrin)
  • naproxen (Aleve)

Prescription-strength versions of these medicines are also available, as are prescription-only NSAIDs. The prescription-only NSAID available in the United States is called celecoxib, sold under the brand name Celebrex.

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What’s the difference, and which kind is safest?

Although both of these kinds of medicines treat pain, acetaminophen and NSAIDs work in different ways.

Acetaminophen lessens pain and fever by stopping the production of prostaglandins in the central nervous system. Acetaminophen is generally considered safe for people with IBD as it does not have any stomach-related side effects. It’s a good choice for pain, headaches, body aches, or fever.

However, acetaminophen is limited in that it cannot reduce swelling.

Over-the-counter NSAIDs reduce pain, swelling, and fever by blocking both COX-1 and COX-2 enzymes in the body. The COX-2 enzyme contributes to pain, swelling, and inflammation throughout the body. The COX-1 enzyme is responsible for helping to protect the gut mucosa.

So, while your pain and swelling will go down when you take NSAIDs, your gut is less protected and could develop irritation or ulcers. NSAID side effects can include heartburn, stomach pain, gastrointestinal (GI) ulcers, or bleeding.

This is why oral NSAIDs may not be safe for those with IBD, especially when taken frequently or in higher doses.

Prescription-only Celebrex belongs to a different class of NSAIDs called COX-2 inhibitors. These mainly target the COX-2 enzyme, and have much less effect on COX-1 (the gut-protective enzyme) than the other NSAIDs. This is good news for people with IBD, because these drugs lessen the chances of GI side effects like ulcers and bleeding.

Keep in mind that GI side effects are still possible, so make sure your GI doctor is monitoring your condition if you take Celebrex.

Can NSAIDs cause flares?

Research is unclear if NSAIDs can cause flares. Some older research has suggested that there may be an association of NSAID use with IBD flares, and for years, people with IBD have been warned not to take them.

However, a recent study states that the association between NSAIDs and flares is due to bias in the way the data has been analyzed. The results of the study determined that NSAIDs are not necessarily associated with flares, but more research is needed to determine the safety of NSAIDs for those with IBD.

Are NSAIDs totally off-limits for people with IBD?

The short answer is no. If your pain also involves swelling, as most injuries do, acetaminophen may not offer enough relief. NSAIDs are ideal for treating minor injuries or for relief after a procedure or surgery. When taken short-term, such as 3–5 times a month, GI side effects are not as likely.

NSAIDs may also be helpful if you have an inflammatory condition such as arthritis or a lot of extra-intestinal pain.

If you do consider taking them, first ask your GI doctor whether they’re OK for you and how frequently you can take them. Your doctor may suggest taking them with food or antacids to prevent GI side effects.

If you’re currently having a lot of gut inflammation or in a flare, your doctor may want you to avoid them entirely.

What are the alternatives to NSAIDs?

To avoid possible GI side effects of NSAIDs, consider these topical or natural remedies:

• NSAID creams: Aspercreme and Bengay contain salicylate, the same ingredient in aspirin, and Voltaren contains ibuprofen. Since they’re used topically, they are safe for your gut. These may be especially helpful if you have other inflammatory conditions in addition to IBD, like joint inflammation and arthritis pain.
• Capsaicin creams: Capzasin and Zostrix are derived from hot pepper and create a warm sensation that can block pain receptors. They can be used for joint pain or nerve pain.
• Counter-irritant patches and creams: IcyHot and Tiger Balm contain menthol or camphor, both of which cause a cold sensation followed by a warm sensation, which distracts your body from pain. They are ideal for muscle aches or sprains.
• Lidocaine: Patches or creams that contain lidocaine are helpful for numbing pain.
• Heat: Heating pads can relieve aches and muscle stiffness by improving circulation. They can also help soothe cramping or gut discomfort.
• Ice packs: These are helpful to lessen pain and swelling from new injuries.
• Turmeric supplements: These can help keep pain under control. Turmeric has been shown to help decrease joint pain related to arthritis. It can also ease menstrual pain.
• Essential oils: Many essential oils can help provide some relief for a variety of ailments. Just make sure to choose quality oils.
• CBD: CBD creams can also provide relief. Be sure to look for a reputable brand that is low in THC to prevent any psychoactive side effects.

Advocate for what works for your body

Since everyone reacts differently to medicines, it’s important to find what works for you. Maybe you already know whether oral NSAIDs cause you to have stomach pain or other side effects. If so, be sure to discuss other options with your provider.

Be aware that many general providers are so used to recommending NSAIDs that they may not stop to consider the side effects for people with IBD.

Shortly after my son was diagnosed with Crohn’s, I took him to an orthopedic provider for a minor sports injury. The provider told him to take prescription-strength ibuprofen as needed. I was surprised the provider did not seem aware this could be problematic for my son’s gut. Thankfully, his pain was mild and could be managed with other options.

When in doubt, run any new recommendations by your GI doctor. For example, my son’s dentist recommended NSAIDs after his recent wisdom teeth surgery. I messaged my son’s GI doctor to ask if it was OK and he said yes. My son needed pain relief the first few days after surgery and was able to take ibuprofen a few times without any GI side effects.

The takeaway

When dealing with aches and pain, know you have options.

Oral acetaminophen is considered safe for those with IBD. Oral NSAIDs can be safe, especially for short-term use. Just remember to proceed with caution and check with your GI doctor first.

Don’t forget to try topical creams or patches, as well as natural remedies such as heat or ice packs, essential oils, and turmeric supplements.