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Treating Pain With Ibuprofen

This Non-Steroidal Anti-Inflammatory Drug Has A Good Track Record — When Used Appropriately

A Consultation with Dr. James Zahrowski

Dear Doctor,
People always seem to be popping ibuprofen for aches, pains, sprains and swelling. Is it really safe and effective, and will it be useful for my upcoming wisdom teeth removal?

Treating Pain With Ibuprofen.

Dear Monica,
This is a good question, as Ibuprofen is regularly used by millions and easily available without a prescription. It is recommended by dentists and doctors for a variety of conditions — including postoperative pain — because it has been studied extensively and has a good track record. People using it should keep in mind, however, that over-the-counter drugs are drugs nonetheless, and should be used appropriately. Let's review some basic information about ibuprofen, and how it compares to other medications.

Sold under many brand names, Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces both pain and inflammation (aspirin is also an NSAID). It does this by blocking substances called prostaglandins (first discovered in the prostate gland) that are released by inflamed tissues as a result of trauma or damage.

Ibuprofen is recommended by dentists and doctors for a variety of conditions — including postoperative pain — because it has been studied extensively and has a good track record.

Steroids (short for corticosteroids) are potent anti-inflammatory medications similar to hormones your body produces naturally to fight stress due to illness or injury. These powerful prescription drugs, which are not used directly for pain relief, suppress the body's natural immune (defense) system and have many side effects. They are used for serious diseases under medical supervision.

Opiates (derived from opium) and opioids (synthetic opiates), such as morphine and codeine, are narcotic painkillers that also have sedative side effects. They act on the brain to depress the central nervous system, thereby controlling pain. These prescription-only drugs can be quite dangerous and habit-forming if abused. Some combination medications contain both opiates and NSAIDs, with the advantages and side effects of both.

Most health professionals prefer NSAIDs for the management of both pre- and post-operative pain because these drugs act at the site of inflammation by directly controlling the substances that cause pain and inflammation. Unlike opioids, they do not impair consciousness. An additional benefit is that several NSAID-class medications, including ibuprofen, are available over the counter, making them more readily accessible and less costly than prescription alternatives.

But NSAIDs, too, should not be abused; they do have side effects. The most common is that they have a blood-thinning effect, especially when used over a period of weeks, and thus bleeding may be more difficult to stop. Additionally, like aspirin, they can damage the stomach lining leading to ulcers and occasionally dangerous bleeding. Ibuprofen is eliminated from the body by the kidneys, and when used excessively can impair and damage these organs. NSAIDs have also been linked to early miscarriage and repeat heart attacks. These side effects are not common, but they too have been backed by evidence-based research. NSAIDs are not recommended during pregnancy, a history of stomach or intestinal bleeding, or a history of heart attacks. NSAID use may also interfere with any beneficial effect of low dose aspirin to prevent heart attacks and strokes, so that they should not be taken together.

Many people don't understand the risks of taking ibuprofen chronically or excessively.

Many people don't understand the risks of taking ibuprofen chronically or excessively. It is usually recommended for adults not to take more than 2400 milligrams of ibuprofen in one day for short-term pain relief, unless otherwise recommended by your doctor. Also, it is possible to have NSAID-induced gastrointestinal bleeding without knowing it. According to the American College of Gastroenterology, it is estimated that more than 100,000 Americans are hospitalized each year and between 15,000 and 20,000 Americans die each year from ulcers and gastrointestinal bleeding linked to NSAID chronic use for pain relief.

In answer to your specific question, a considerable amount of evidence-based research — the gold standard for scientific proof — has demonstrated that a single, 400 milligram oral dose of ibuprofen is safe and effective in providing relief of moderate to severe postoperative pain in adults for approximately five hours. A higher dose of 600 mg increases pain relief in adults, and it is always recommended that it should be taken with food in order to prevent stomach upset. Therefore, ibuprofen may well be a good choice to control any swelling or pain you experience after your wisdom teeth extraction. However, that decision needs to be made with input from your dentist (or surgeon), taking into account the severity of your pain, the type and complexity of your surgery, your own medical and drug history, and your practitioner's experience in administering this drug. The two of you should discuss this before your surgery for the sake of your own safety and comfort.