Pain Management Center

HomePatient EducationNSAIDS

Nonsteroidal Anti-inflammatory Pain Relievers and Acetaminophen

NSAID stands for nonsteroidal anti-inflammatory drug.  NSAIDS reduce pain, inflammation and fever. As their name suggests, these medications help reduce inflammation (swelling, redness, heat) after an injury such as a fracture or sprain.  They also decrease inflammation in areas of arthritis, bursitis, or other similar conditions.  By reducing inflammation, they can also reduce pain, since some of the body’s natural chemicals that cause inflammation also cause pain.  In addition to decreasing swelling, the NSAIDs also reduce fevers.  Drugs in this category include aspirin, ibuprofen, ketoprofen, naproxen, among others. 

 How Should I Take These Medications?

Always take your NSAIDs with food because they can be irritating to the stomach.  The easiest way to take your dose is with your meals.  You may also take it with milk or antacids.

What Doses are Appropriate?

Some NSAIDs are available without a prescription.  It is very important that you do not exceed the recommendations for safe dosing provided on each packet. Ibuprofen (Advil, Motrin, etc) is available in 200 mg tablets over-the-counter or without a prescription.  The maximum daily dose is 2,400 mg or 12 tablets in a 24-hour period.  It is also important not to exceed 800 mg per dose.  Naproxen and ketoprofen are other NSAIDs available without a prescription.  They are all comparable ineffectiveness when used as labeled.
What Are the Side Effects of NSAIDs?

Stomach upset and diarrhea are the most common reactions people report with anti-inflammatory drugs.  These medications may irritate the lining of the stomach and, less commonly, lead to ulcers in the stomach.  They can also cause the blood to clot more slowly than usual, leading to easy bruising.  When taken in excessive amounts for periods of time, NSAIDs can cause damage to the kidneys.  High doses of NSAIDs over time can increase blood pressure and occasionally that is associated with heart problems.   NSAIDs are safe and effective for most people if taken as prescribed or as labeled on the non-prescription NSAID containers.  All NSAIDs should be use at the lowest effective dose for the shortest possible time.  When used for more than a few weeks, your blood pressure should be monitored periodically.  Discuss that with your doctor.

What are the Newer COX-2 inhibitor NSAIDs

These newer NSAIDs cause fewer digestive system problems.  Only one I snow available in the United States, celecoxib (Celebrex).  This drug is safe and effective when used as prescribed in appropriate patients.


Acetaminophen is a generic name for Tylenol. Many other brands are available and the medication is also available generically (as acetaminophen).  No one brand is necessarily any better than another. Acetaminophen is commonly used as an analgesic to treat pain or as antipyretic to reduce fever.  It is not an antiinflammatory agent.

What Doses are Appropriate?

Acetaminophen is available without a prescription. It is most commonly available as regular-strength tablets (325 mg) and extra-strength tablets (500 mg).  Acetaminophen is a common ingredient in combination pain and cold medications.  The maximum daily safe dose of acetaminophen is 4000 mg or 4 gm.  This is equal to 8 extra-strength tablets or just 12 regular strength tablets a day. Higher doses can cause serious liver toxicity.  Persons who have preexisting liver disease or who drink a lot of alcoholic beverages \are at greater risk of liver toxicity form acetaminophen.    Many prescription analgesics also contain acetaminophen. Remember that is you are taking any prescription pain medication containing acetaminophen that this needs to be calculated into your daily maximum intake. 

What are the Side Effects of Acetaminophen?

Most people do not have side effects from an occasional dose of acetaminophen or from low doses taken on a regular basis.  Daily use over a prolonged period of time can cause liver or kidney damage.