NSAID Risks for Chronic Joint Pain: Why Long-Term Use Is Problematic

Key Research Findings

Long-term NSAID use for joint pain carries significant risks:

25% increased cardiovascular events (heart attacks, strokes)
3 extra heart attacks per 1,000 patients/year with high-dose use
1-2% annual GI bleeding rate in patients 65+
FDA black box warning for cardiovascular and GI risks
Kidney function decline with chronic use
Local alternatives like HA injections avoid these systemic risks

The Hidden Cost of Daily Pain Pills

Millions of Americans take NSAIDs (non-steroidal anti-inflammatory drugs) daily for joint pain. Ibuprofen, naproxen, and prescription-strength versions seem safe—they’re available over the counter, after all.

But for chronic use, especially in older adults, the risks add up. What helps your joints may hurt your heart, stomach, and kidneys.

What Are NSAIDs?

Common NSAIDs

Generic Name	Brand Names	Type
Ibuprofen	Advil, Motrin	OTC/Rx
Naproxen	Aleve, Naprosyn	OTC/Rx
Celecoxib	Celebrex	Rx (COX-2 selective)
Meloxicam	Mobic	Rx
Diclofenac	Voltaren	OTC/Rx
Indomethacin	Indocin	Rx

How They Work

NSAIDs block enzymes called cyclooxygenases (COX-1 and COX-2) that produce prostaglandins—chemicals involved in inflammation and pain. This reduces:

Joint swelling
Pain signals
Stiffness

The problem: Prostaglandins also protect your stomach lining, maintain kidney function, and help regulate blood clotting. Blocking them causes systemic side effects.

Cardiovascular Risks

The Evidence

Research Findings:

Multiple large studies confirm cardiovascular risks from chronic NSAID use:^[1][2]

Study Finding	Risk Increase
All cardiovascular events	25% higher
Heart attacks (high dose)	3 extra per 1,000 patients/year
Stroke risk	Elevated
Heart failure risk	1.5-2x higher

What “25% Increased Risk” Means

If your baseline heart attack risk is 4% per year, chronic NSAIDs increase it to 5%

For someone already at higher risk (diabetes, high blood pressure), the absolute increase is larger

Risk persists regardless of time since starting NSAIDs—it doesn’t “get safer” with continued use

FDA Black Box Warning

The FDA requires a black box warning (the strongest type) on all NSAIDs stating:^[3]

“NSAIDs may increase the risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke, which can be fatal. This risk may occur early in treatment and may increase with duration of use.”

Gastrointestinal Risks

The Bleeding Problem

NSAIDs damage the protective mucus layer of the stomach and intestines, leading to:

Erosions and ulcers - Raw spots that can bleed

GI bleeding - 1-2% annual rate in 65+ population

Perforation - Hole in stomach or intestine (rare but life-threatening)

Intestinal inflammation - Damage beyond the stomach

Risk Factors for GI Bleeding

Factor	Increased Risk
Age 65+	2-4x higher
History of ulcers	4-5x higher
Taking blood thinners	3-6x higher
Taking corticosteroids	4x higher
Multiple NSAIDs	Significantly higher
High-dose NSAIDs	Dose-dependent increase

The Numbers

For every 1,000 seniors taking daily NSAIDs for one year:

10-20 will have a GI bleeding event
2-4 will require hospitalization
1 may experience a life-threatening bleed
Long-term use accumulates these risks year over year

Kidney Risks

How NSAIDs Harm Kidneys

Prostaglandins help maintain blood flow to the kidneys. NSAIDs reduce this protective mechanism:

Acute kidney injury - Sudden decline in kidney function

Chronic kidney disease progression - Accelerates existing damage

Fluid retention - Worsens blood pressure and heart failure

Electrolyte imbalances - Can affect heart rhythm

Who’s at Higher Risk?

Patients with existing kidney disease
Diabetics
Those with heart failure
Patients taking diuretics or ACE inhibitors
Dehydrated individuals

The Polypharmacy Problem

Medicare Patients and Drug Interactions

The average Medicare beneficiary takes 4-5 prescription medications. Adding chronic NSAIDs creates interaction risks:^[4]

Medication	NSAID Interaction
Blood thinners (warfarin, Eliquis)	Increased bleeding risk
Blood pressure medications	Reduced effectiveness
Diuretics	Kidney damage risk
SSRIs	GI bleeding risk
Corticosteroids	GI bleeding risk
Lithium	Toxicity risk

The Safer Alternative

What if you could get pain relief without adding another systemic medication to the mix?

Local Alternatives: Why HA Injections Make Sense

The Local vs. Systemic Difference

Comparison:

Factor	NSAIDs (Oral)	HA Injections
Route	Systemic (whole body)	Local (joint only)
Daily dosing	Required	Not needed (1-5 injections total)
Cardiovascular risk	Increased	None
GI bleeding risk	Increased	None
Kidney effects	Negative	None
Drug interactions	Multiple	None
Blood sugar effect	Minimal	None
Duration of benefit	Hours	6-12 months

Why This Matters for Seniors

For a 70-year-old with knee osteoarthritis who also has:

High blood pressure
Type 2 diabetes
Mild kidney disease
On 5+ medications

Daily NSAIDs are a significant risk. HA injections provide pain relief without systemic exposure.

When Are NSAIDs Appropriate?

Short-Term Use

NSAIDs still have a role when used appropriately:

Acute flares - Short courses (7-14 days) for inflammation spikes

As-needed use - Occasional, not daily

Lowest effective dose - Minimum needed for relief

With gastric protection - PPI co-prescribed if needed

Risk Mitigation Strategies

If you must use NSAIDs:

Use the lowest effective dose
Take for the shortest duration possible
Avoid combining with blood thinners
Consider a proton pump inhibitor for GI protection
Monitor kidney function if on other medications
Check blood pressure regularly

Building a Safer Treatment Plan

The Multimodal Approach

Rather than relying on daily NSAIDs, consider combining:

Comprehensive OA Management:

HA injections - 6-12 months of relief without systemic effects
Physical therapy - Strengthens supporting muscles
Weight management - Reduces joint stress (1 lb = 3-4 lbs off knee)
Acetaminophen - For mild pain (no GI/CV risk, but watch liver)
Topical NSAIDs - Lower systemic absorption than oral
Activity modification - Smart exercise, avoid high-impact
Occasional oral NSAIDs - As-needed for flares, not daily

Working with Your Doctor

Questions to ask about your NSAID use:

Do I need to take this every day, or can I use it as needed?
What are my risk factors for side effects?
Are there local treatments like HA injections that could reduce my NSAID need?
Should I be on a stomach-protecting medication?
How often should we check my kidney function?

The Evidence for Medication Reduction with HA

Studies show HA injections can help reduce medication use:^[5]

Reduced NSAID prescription fills after HA treatment

Decreased opioid utilization

Improved function without daily pills

6% reduction in opioid prescriptions in some studies

The Bottom Line

Rethinking Daily NSAIDs

For chronic joint pain, daily NSAIDs are a poor long-term strategy:

Cardiovascular risk increases 25%
GI bleeding affects 1-2% of seniors annually
Kidney function can decline
Drug interactions multiply with polypharmacy
Relief is temporary (hours), requiring constant dosing

Local alternatives like HA injections offer:

Pain relief lasting 6-12 months
No systemic side effects
No drug interactions
No cardiovascular, GI, or kidney risks
Potential to reduce or eliminate NSAID use

If you’ve been taking ibuprofen or naproxen daily for months or years, it’s worth asking your doctor about safer alternatives.

Find Providers Who Offer Alternatives

Locate specialists who can discuss local treatment options that reduce your need for daily pain pills.

Imaging-Guided Medicare Accepted

Your Name

Email Address

ZIP Code

Used to find providers in your area

Primary Condition

Insurance Type

By checking this box, I consent to receive calls and text messages (including autodialed and prerecorded messages) from Joint Pain Authority and its partners at the phone number provided, regarding healthcare services and treatment options. I also consent to receive marketing communications and understand these may include promotional offers. Message and data rates may apply. Message frequency varies. Reply STOP to opt out of texts. I understand this consent is not required to receive services. View full terms.

Required to submit this form

Your information is secure. See our Privacy Policy and Terms of Service.

Thank You!

We've received your request. A provider specialist will contact you within 1-2 business days to help you find the right care.

What happens next?

1 We'll verify your insurance coverage
2 Match you with quality providers in your area
3 Contact you to discuss your options

Questions? Browse our guides:

How to Choose a Provider

References

Cardiovascular risk of NSAIDs. Circulation, 2012. AHA Journals
NSAID cardiovascular events analysis. Nature Scientific Reports, 2024. Nature
FDA Drug Safety Communication: NSAIDs and Cardiovascular Risk. FDA.gov
NSAID gastrointestinal risks in elderly. PMC. PMC10156439
HA injections and medication reduction. PMC. PMC8619730
High-dose NSAID effects. Oxford Clinical Trial Service Unit. CTSU

Safer Pain Management

Stay informed about alternatives to chronic medication use for joint pain.

Join 10,000+ readers. No spam.