All Over-the-Counter Pain Relief Medications Contain Both Risks and Benefits Interview with:

Charles H. Hennekens, M.D., Dr.P.H, FACPM, FACC
Sir Richard Doll Professor and Senior Academic Advisor
Charles E. Schmidt College of Medicine
Florida Atlantic University  What is the background for this study?  What are the main findings?

Response: About 29 million Americans use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain. Every year in the United States (US),  NSAID use is attributed to  approximately 100,000 hospitalizations and 17,000 deaths. In addition, the U.S. Food and Drug Administration recently strengthened its warning about risks of non-aspirin NSAIDs on heart attacks and strokes. 

While each over the counter and prescription pain reliever  has benefits and risks, deciding which to use is complicated for healthcare providers and their patients. What should readers take away from your report?

Response: All these drugs have benefits and risks Aspirin decreases inflammation as well as coronary events and stroke but increases gastrointestinal symptoms and bleeding but without adverse hepatic or renal consequences.   Non-aspirin NSAIDS decrease inflammations but  have been associated with adverse  major coronary events and stroke with long term use as well as major upper gastrointestinal and kidney side effects as well as electrolyte imbalances such as high sodium or potassium and even heart failure. Cyclooxygenase 2 (COX2) inhibitors were developed primarily because of their more favorable GI side effect profile relative to aspirin and traditional non-aspirin NSAIDs but confer adverse cardiovascular as well as hepatic and renal effects.  Acetaminophen  has no clinically relevant anti-inflammatory properties, and  accounts for more than 50 percent of drug overdose related liver failure and about 20 percent of liver transplant cases as well as kidney disease.  . What recommendations do you have for future research as a result of this work?

Response: Further research should include direct comparisons in randomized trials of sufficient size and duration. Is there anything else you would like to add?

Response: . The factors in the decision of whether and, if so, which NSAID to  prescribe for relief of pain from inflammatory arthritis should not be limited to risks of  CVD or GI side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.


Manas A. Rane, Alexander Gitin, Benjamin Fiedler, Lawrence Fiedler, Charles H. Hennekens. Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs. Journal of Cardiovascular Pharmacology and Therapeutics, 2019; 25 (1): 3 DOI: 10.1177/1074248419871902

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Last Updated on February 7, 2020 by