What’s the Difference Between COX-2 Inhibitors and NSAIDs?

For millions of Americans, pain is an everyday occurrence. In fact, it’s estimated that almost one-third of the American population (over 100 million people) suffer from chronic pain. Whether its the sting chronic lower back pain, or the unrelenting pain or osteoarthritis (wear and tear arthritis) millions of Americans are looking for simple solutions to manage their pain. If you suffer from chronic pain, its essential you know what options are out there to manage the pain. This can be done in a whole host of ways from reading articles like this one to getting in contact with specialist pain management clinics.



How do NSAIDs Work?


The simplest painkillers you might be offered are NSAIDs. You can often buy these drugs (eg Ibuprofen and Naproxen) over the counter and many people take them for regular lumps and bumps or a simple headache. But how do they actually work?


NSAIDs or Nonsteroidal anti-inflammatory drugs as their non-abbreviated name, are drugs that inhibit inflammation. They work by inhibiting two enzymes, Cyclooxygenase 1 and 2 (often shorted to COX 1 and COX 2). These enzymes produce small molecules that cause inflammation in our tissues (wherever that may be ie a knee or a back or your head). These inflammatory molecules cause the nerves in your body to become irritated and excitable. They are far more likely to send pain signals up to the brain when these inflammatory molecules are floating around in the tissues. So by blocking the enzyme that MAKES these molecules, we get less inflammation and fewer pain signals up to the brain!


How do COX-2 inhibitors work?


Unfortunately whilst traditional NSAID medications are great at relieving pain they also have a byproduct to reducing the production of prostaglandins in the stomach. Elsewhere in the body prostaglandins cause inflammation and result in increased pain – however in the stomach they play a protective role over acidification. Loss of these prostaglandins can result in increased stomach acid environments that can lead to ulcers. Now, inhibition of COX-1 is most involved in this and so the COX 2 specific inhibitors were designed (Eg celecoxib etc).


These drugs work by the same mechanism but reduce the gastrointestinal side effects of traditions nonsteroidal anti-inflammatory drugs like Ibuprofen and Naproxen.


What’s better COX2 or NSAIDS?


The answer seems obvious right? COX-2 inhibitors are superior? Well, it’s not that simple. After their development, it was noted that COX-2 inhibitors can cause heart disease in some patients (or at least increased their risk of developing heart disease). This is over and above the risk of using normal NSAIDs. Unfortunately, there is no real answer on which is better. Whilst COX inhibitors might be better for those struggling with GI side effects of NSAIDs, the risk of heart disease needs to be taken into consideration. In fact, the risk of heart disease means many clinicians are overly cautious when prescribed COX-2 inhibitors. As with many things in medicine, the answer is in the individual. Having a good honest conversation about the pros and cons of each drug with a specialist doctor is the most important thing.