NSAID Alternatives for Pain and Inflammation
Article written by
Tina MagrabiSenior Content Writer
Content reviewed by
Dr. Lewis JasseyMedical Director - Pediatric Medicine
Table of contents
If you’ve ever experienced a headache, body pain, inflammation, or fever, there’s a good chance you’ve used a non-steroidal anti-inflammatory drug (NSAID), such as Ibuprofen, aspirin, or Aleve. While effective for short-term relief, these drugs carry severe long-term health risks.
So, what NSAID alternatives exist? And can cannabidiol (CBD) play a role as an all-natural alternative to traditional pain-killing medications? Learn how NSAIDs work and if CBD or cannabis could be a better option for managing pain.
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How NSAIDs Work
NSAIDs reduce inflammation in the body to alleviate several types of general or localized pain and ailments, including:
- Dental pain
- Muscle aches and pains
- Menstrual cramps
- Rheumatoid arthritis (RA)
But how? Essentially, NSAIDs work like steroids — namely corticosteroids — without causing the same side effects of these powerful drugs (including weight gain, thinning of the skin, and osteoporosis). They function by reducing the production of prostaglandins, naturally occurring chemicals the body uses to promote healing by triggering inflammation, pain, and fever. NSAIDs also help with blood clotting and protecting the stomach and intestines from acid damage that certain foods can cause.
The process of reducing prostaglandins involves blocking the enzymes that produce them, called cyclooxygenases 1 (COX-1) and cyclooxygenases 2 (COX-2). But that’s where the potential for severe health consequences comes into play.
Side Effects and Risks of NSAIDs
Since COX-1 is responsible for producing prostaglandins that aid in blood clotting and protection of the stomach and intestines, an NSAID that blocks that particular enzyme can leave long-term users vulnerable to several conditions, including:
- Increased risk of bleeding
- Kidney and liver failure
Additionally, the Food and Drug Administration (FDA) warns that NSAIDs increase the risk for heart attack and stroke. There is also the potential of NSAIDs clashing with other types of medication, increasing their negative side-effects or increasing the chances of overdose (e.g. anticoagulant medications like warfarin, antidepressants like fluoxetine, or corticosteroids like prednisolone).
However, there are also more minor side effects associated with short-term use of NSAIDS, like:
- Stomach ache
- Ringing in the ears (tinnitus)
- Allergic reactions
These potential side effects make alternative forms of therapy a necessity.
Alternatives to NSAIDs for Inflammation
There are several NSAID alternatives you can try to relieve inflammation and pain, but the right option for you depends on a number of factors. We’ll guide you through some options below.
The cannabinoid CBD can potentially be one of the effective NSAID alternatives. There’s growing evidence to suggest CBD can alleviate pain and reduce effects felt from a number of different sources, including:
- Headaches and migraines
- Multiple Sclerosis
- Muscle Soreness
CBD helps boost natural hormones found in the endocannabinoid system (ECS), whose receptors bind to botanical compounds in the cannabis plant. One particularly useful hormone is called anandamide, which helps regulate pain and mood. Ingesting CBD can reduce cannabinoid receptors’ ability to “soak up” and process anandamide, meaning more is available in the bloodstream. By amplifying anandamide, we’re better able to control how we feel on a daily basis. But the benefits of CBD don’t stop there with the ECS. The cannabinoid can also have an indirect effect on both types of receptors (CB1 and CB2) found in the ECS.
Although CBD doesn’t form a strong bond with CB1 receptors, which are found mostly in the brain and nervous system, it can help them receive the body’s endocannabinoids. Sometimes, the body breaks down beneficial cannabinoids too quickly, but by both amplifying natural hormones and helping the body receive healing properties from those hormones, CBD users may feel relief.
Additionally, CBD’s interaction with CB1 receptors can help users sleep better. As mentioned above, there isn’t a tight bond between CB1 receptors and CBD, but their interaction can help control the body’s serotonin release. Whether that means speeding up or slowing down the release, better control can mean a calming effect.
CBD also indirectly influences how CB2 receptors behave. Those receptors, which have a high presence in the gastrointestinal (GI) tract and immune system, are thought to play a role in regulating inflammation and pain. When CBD influences CB2 receptors, the result is a more balanced ECS system that may help a user experience less pain and decrease inflammation.
To emphasize, NSAIDs work by blocking COX-1 and COX-2 enzymes, but the issue is COX-1 enzymes produce prostaglandins that protect the stomach and intestines. However, there are some anti-inflammatory medications that are still considered NSAIDs but block COX-2 enzymes and impact COX-1 enzymes much less. These are known as COX-2 inhibitors. While this class of drugs might be a better option, there’s still risk involved. The acidic form of CBD, cannabidiolic acid (CBDA), is also a COX-2 enzyme inhibitor.
For pain, non-NSAID pain relievers like acetaminophen — commonly called Tylenol or paracetamol— are a potential alternative. Instead of targeting inflammation, this class of drugs, called analgesics, targets the pain specifically by raising the user’s pain threshold. Basically, more pain would have to develop before the person experiences it. One downside is analgesics don’t offer any relief from inflammation.
One interesting aspect of acetaminophen that has only recently been discovered is that it relieves pain through CB1 receptors. In fact, we actually know very little about how acetaminophen works, yet millions of people the world over use it every day, trusting it to do its job. This can be problematic because, for some types of pain (e.g. back pain), it just doesn’t as well as we thought it might. This means that many people could be taking medication that is not suitable for them.
Acupuncture is an ancient, multi-system treatment that is becoming more mainstream. This type of procedure uses needles to target different points in a person’s body with needles to stimulate nerves. The idea is that the activated nerve sends signals to the brain, triggering the release of neural hormones that give relief. A 2012 meta-analysis of 29 studies found that acupuncture was effective in treating chronic pain.
For some people, relief can be as easy as just getting some extra sleep. In a study conducted at Johns Hopkins University, researchers found that participants who were awakened for long stretches during the night experienced lower pain thresholds. By disrupting normal sleep patterns, the body’s pain control mechanisms were also disrupted.
Foods That Fight Inflammation
A healthy diet likely won’t be able to immediately relieve aches and pains, but proper nutrition is one of the NSAID alternatives for fighting inflammation. In general, following a diet consisting of whole — and fewer processed and prepackaged — foods provides your body with antioxidants and nutrients needed to fight inflammation.
Strawberries. Blueberries. Raspberries. Take your pick, because they’re all a good way to fight inflammation. The reason: Berries contain anthocyanins, compounds that not only give berries their vibrant colors but are also shown to help fight inflammation.
Like berries, grapes contain anthocyanins. However, they also include the powerful antioxidant known as resveratrol. Resveratol is a polyphenol and research shows it can help inhibit inflammation.
Fatty fish — including salmon, sardines, herring, mackerel, and anchovies — contain large amounts of the omega-3 fatty acids EPA (eicosapentaenoic acid), and DHA (docosahexaenoic acid). EPA and DHA are both shown to reduce inflammation that contributes to cardiovascular disease, high blood pressure, and more. If you can’t eat fatty fish, taking a fish oil supplement containing at least 30 percent omega-3s can still provide the same benefits.
Like fatty fish, nuts — especially varieties high in fat like walnuts, almonds, macadamia nuts, pecans, and hazelnuts — contain high amounts of healthy omega-3s and are shown to help fight against inflammation.
This green veggie may (or may not) be on your list of favorite foods to eat, but it should be. The reason: Broccoli is full of sulforaphane, an antioxidant that fights inflammation by lowering certain inflammation-causing compounds.
Adding a slice of avocado to a burger might be enough to help fight inflammation, at least according to a 2013 study published in the journal Food & Function. In that study, researchers found that even two ounces of avocado added to a burger was enough to lower inflammatory responses in participants. Even better: avocados are also full of monounsaturated fats, which can help inflammation.
Green tea has a reputation as one of the healthiest beverages you can drink and studies show it lives up to the hype. Green tea has plenty of healthy ingredients, including epigallocatechin-3-gallate (EGCG), a substance known to inhibit inflammation and prevent cellular damage.
Edible mushrooms — specifically portobello, shitake, and truffles — have antioxidants that are shown to help prevent inflammation. However, cooking mushrooms might reduce some of their anti-inflammatory properties and it is not generally advisable to eat raw mushrooms
Cherries are a delicious snack and they’re a great way to fight inflammation, thanks to the antioxidant power of anthocyanins and catechins. They can also have long-lasting effects in the fight against inflammation. In one study, researchers asked participants to eat 280 grams of Bing sweet cherries for one month, then stop. Not only did the participants experience a drop in inflammation, but that decrease lasted for another 28 days.
While not as widely known as some of the other foods on this list, turmeric is another NSAID alternative thanks to the curcumin found inside. Curcumin is an antioxidant clinically shown to help fight inflammation, especially when paired with other spices like black pepper. The two together create a synergistic effect that helps the body get the most out of turmeric.
Black pepper also contains an atypical cannabinoid and terpene called beta-caryophyllene, which can partially bind to CB2 receptors, helping lower inflammation. There is a lot of interest in beta-caryophyllene as a treatment for various conditions, including arthritis, inflammatory bowel diseases (IBDs), diabetes, and plenty of other conditions where pain and inflammation are involved. (Which is most of them.)
Ginger is a powerful tool in the fight against inflammation. The reason: It contains gingerol, a substance known for both its inflammation-fighting powers and its ability to fight bacteria growth.
Garlic adds undeniable taste to any number of dishes, but it’s also a tool to use in the fight against inflammation. Garlic contains sulfur-like compounds known for their ability to reduce swelling in the joints. Cannabis also contains many “smelly molecules” that are similar to the pungent ones found in garlic, called volatile sulfur compounds (VSCs).
Eating dark chocolate made with at least 70 percent cocoa can have anti-inflammatory effects. The reason: dark chocolate contains flavonols, an antioxidant proven to reduce inflammation.
Extra Virgin Olive Oil
Rich in monounsaturated fats, extra virgin olive oil is a staple in the healthy Mediterranean diet because of its diverse uses and anti-inflammatory power. The main inflammation fighter in extra virgin olive oil is oleocanthal, an antioxidant that is said to act like ibuprofen.
Tomatoes are one of the most versatile foods out there — and one of the most nutritious. They’re full of vitamins, including vitamin K, potassium, vitamin C, and folate. But the real inflammation buster inside tomatoes is the antioxidant lycopene. Lycopene is a fat-soluble nutrient, meaning you’ll get more of the benefits if you eat it with a healthy fat source, like extra virgin olive oil.
CBD and Cannabis as NSAID Alternatives
To target a specific area, cannabis and CBD topicals are a potential solution, as you can apply them directly to the affected area. Or, if you’re looking for full-body relief, there are a variety of CBD tinctures, oils, vapes, and edibles available. Keep in mind that, no matter which CBD product you choose, you can control the dosage for personalized results.
The Bottom Line
NSAIDs are effective anti-inflammatories, but they come with a host of long-term risks and side effects. For some people, CBD products may offer a safer and equally effective alternative to using NSAIDs. Be sure to ask your doctor before replacing any current medications — either prescribed or over the counter — with CBD or other NSAID alternatives.
Explore CBD and cannabis as natural alternatives to NSAIDs. The doctors at Leafwell are here to help you navigate the easy online process and apply for your MMJ card.
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Frequently Asked Questions
What is a good substitute for NSAIDs?
While research is emerging, CBD products may be a good substitute for NSAIDs. All-natural and well-tolerated with few side effects, CBD oils and other topicals could be a better long-term tool in the fight against inflammation.
What is another alternative for someone allergic to aspirin?
People who are allergic to aspirin might consider CBD products, which come with fewer risks and side effects. Consult with your physician before starting any new medication, including CBD. However, those using aspirin for blood thinning rather than pain-killing may require another, more suitable alternative like clopidogrel.