Long-term NSAID use can harm the stomach, kidneys and heart, and can raise blood pressure. The risk is higher with daily use, high doses, age 65 or older, or other health conditions. Short, occasional use is usually safer. If you need pain pills most days, see a doctor to find the cause.
What Are NSAIDs and How Do They Work?
NSAIDs (non-steroidal anti-inflammatory drugs) are pain relievers that reduce pain, swelling and fever. They work by blocking enzymes called COX-1 and COX-2, which make chemicals called prostaglandins. Common examples are ibuprofen, naproxen, diclofenac, celecoxib and aspirin.
People take them for headaches, period pain, back pain and joint pain from conditions like osteoarthritis. The catch is that prostaglandins also help protect the stomach lining and keep blood flowing to the kidneys. Blocking them is why side effects can appear.
Many NSAIDs are sold over the counter, and some are mixed into combination tablets. This makes it easy to take more than one without realising it.
What Counts as Long-Term NSAID Use?
There is no single cut-off. In practice, long-term use means taking NSAIDs regularly, often daily, for weeks or months. Doctors worry most when the dose is high, the use is daily, or the person already has risk factors such as kidney, heart or stomach problems.
A few tablets for a sprain are very different from a daily tablet for months of knee or back pain. The longer and higher the use, the more the risks add up.
Hidden Risks of Long-Term NSAID Use
1. Stomach Ulcers and Bleeding
NSAIDs can irritate the stomach and gut lining. This can cause ulcers, and ulcers can bleed. The chance rises with regular use over weeks or months, while a few days in a row is unlikely to cause an ulcer.
For scale, the German health-information site informedhealth.org says that with high, prescription-strength doses taken over a longer time, about 1 to 2 in 100 people have serious stomach or bowel problems. It says serious problems are very rare with short-term over-the-counter use.
Your risk is higher if you:
- are over 65
- have had a stomach ulcer or have an H. pylori infection
- take steroids, blood thinners, or antidepressants such as SSRIs
- take more than one NSAID at a time
- smoke or drink alcohol heavily
Symptoms can include burning stomach pain, indigestion, bloating, nausea, black or tar-like stools, or vomiting blood.
2. Kidney Damage
NSAIDs reduce blood flow to the kidneys. The National Kidney Foundation says high doses and long-term use may harm the kidneys, even healthy ones, and people who already have kidney problems may be especially sensitive.
For this reason, NSAIDs are generally not recommended for people with reduced kidney function. Some blood pressure medicines can add to the strain (see the medicine interactions below).
3. Heart Attack, Stroke and High Blood Pressure
NSAIDs can raise the risk of heart attack and stroke. In 2015, the US FDA strengthened its warning on non-aspirin NSAIDs. It said the risk can start in the first weeks of use, may rise with longer use and higher doses, and can occur even in people without heart disease.
Not all NSAIDs carry the same heart risk. The Arthritis Foundation notes that naproxen appears less likely to harm the heart than some others, but it is linked to stomach bleeding, so it may be a poor choice if you have had ulcers. In other words, no NSAID is risk-free.
NSAIDs can also cause fluid retention and raise blood pressure, and some can interact with blood pressure medicines.
4. Medicine Interactions
Taking NSAIDs with other medicines can add risk. Some examples:
- Blood thinners (such as warfarin) raise the risk of serious bleeding.
- ACE inhibitors, ARBs and water pills (diuretics) combined with NSAIDs can strain the kidneys.
- SSRIs and SNRIs can raise the bleeding risk further.
- Lithium and methotrexate can be affected by NSAIDs.
This list is not complete. Always show your full medicine list to your doctor or pharmacist.
5. Hiding the Real Problem
NSAIDs ease pain and swelling, but they do not treat why the pain started. If you need them most days, the cause, such as a worn joint, an irritated tendon or a pinched nerve, may still need attention. Pain that keeps coming back deserves a proper assessment, not a bigger dose.
Who Should Be Extra Careful With NSAIDs?
Talk to a doctor or pharmacist before using NSAIDs regularly if you:
- have kidney disease
- have heart disease, a past heart attack, stroke or high blood pressure
- have had stomach ulcers or bleeding
- are 65 or older
- have type 2 diabetes
- have ulcerative colitis or Crohn’s disease
- take blood thinners or other interacting medicines
- are pregnant (use after week 20 may harm the baby’s kidneys, heart and lungs, so many professionals advise avoiding NSAIDs throughout pregnancy)
Warning Signs to Watch For
Get urgent medical help if you have:
- black or tar-like stools, or vomiting blood
- chest pain or sudden breathlessness
- sudden weakness on one side of the body, face drooping, or trouble speaking
Speak to your doctor soon if you notice:
- stomach pain or indigestion that keeps returning
- swelling in the feet or ankles
- higher blood pressure readings than usual
How to Use NSAIDs More Safely
If your doctor says NSAIDs are right for you, these habits lower the risk:
- Use the lowest effective dose for the shortest time needed.
- Follow the label and never exceed the daily limit.
- Do not combine two NSAIDs. Check labels, because some products contain an NSAID without saying so clearly.
- Take them with food, and limit alcohol.
- Share your full medicine list with your doctor and pharmacist.
- If you need long-term use, ask whether a stomach-protecting medicine is needed.
- Keep a pain diary of when you take tablets and how well they work. It helps your doctor decide the next step.
Safer Ways to Manage Long-Term Pain
If you rely on tablets for months, ask what else could help. Options depend on the cause of your pain, and your doctor will choose what fits you:
- Other medicines: paracetamol (acetaminophen) does not reduce swelling, and it can harm the liver at high doses. Topical NSAIDs (gels and creams) cause fewer effects in the rest of the body, but still ask first.
- Movement-based care: physiotherapy can build strength, improve movement and reduce strain on painful joints.
- Targeted treatments: depending on the diagnosis, a pain specialist may suggest nerve blocks, PRP therapy, or radiofrequency ablation for certain types of persistent pain. These are not right for everyone, and results vary.
- Daily habits: good posture, hot or cold packs, better sleep, and managing stress can all affect pain.
When Should You See a Pain Specialist?
Book a visit if you:
- need pain tablets most days
- have pain lasting more than a few weeks
- find tablets are working less well
- have kidney, heart or stomach conditions and still need pain relief
- are unsure which medicine is safe for you
A pain specialist can find the source of pain and plan treatment with less reliance on daily tablets.
Take the Next Step
NSAIDs can help in the short term, but they are not meant to be the only plan for ongoing pain. If you rely on tablets most days, it is worth finding out why. Meet our specialists or contact us to discuss your pain and your options.