Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most effective medications we have to reduce both pain and inflammation. But you need to be aware of several things when using these very helpful medications.

One of the most common side effects of NSAIDS (aspirin, ibuprofen, naproxen and others) is gastritis, ranging from an upset stomach to severe damage to the stomach lining. They also inhibit the ability of platelets to form blood clots, which can lead to abnormal bruising and bleeding.

Other common side effects are increased blood pressure and swelling in the legs. Long-term use of high doses can also be harmful to the kidneys, similarly to acetaminophen.

NSAIDs can reduce the beneficial effects of aspirin for preventing heart attack or stroke. You can minimize that effect by taking the aspirin at least one to two hours before or after any dose of NSAID.

When used in high enough doses to control pain, aspirin (even enteric-coated), is among the most likely NSAID to cause gastritis and bleeding. I prefer to prescribe naproxen or another NSAID, taken with food to reduce the risk of gastritis.

If those NSAIDs cause serious side effect like gastritis or elevated blood pressure, you might want to consider celecoxib (Celebrex®). Celecoxib is a COX-2 inhibitor that works like the NSAIDs, but is just a little more selective in the types of changes it causes inside our cells.

The result is less risk of upset stomach, bleeding, and high blood pressure. One caution: If you are allergic to sulfa antibiotics (or any other sulfa-containing drugs), then you shouldn't take celecoxib because you might have an allergic reaction.

Now a few words about the true cardiac risk of taking NSAIDs and COX-2 inhibitors: In recent years, there has been a lot of concern about these medications "causing" heart attacks and strokes. Studies show that all of them (not just Vioxx® and Bextra®, which were removed from the market in 2004) increase the risk of heart attack by about 50-80 percent if taken for many years in moderate-to-high doses.

While that risk is certainly something to be concerned about, I suggest keeping it in perspective. Smoking, diabetes, and uncontrolled high blood pressure each increase the risk of heart attack by about 10-20 times (1,000-2,000 percent).

So, by comparison, the risks of these medications are much smaller. And, although NSAIDs and COX-2 inhibitors could potentially reduce your quantity of life (how long you live), you might want to weigh that against your quality of life with or without them.

To achieve the best balance of pain control and safety, I suggest that you first eliminate or control as many of the common heart attack risks as you can: smoking, diabetes, high blood pressure, high cholesterol, obesity, and lack of exercise.

Then, take the maximum safe daily dose of acetaminophen for baseline pain control, and add in only as much NSAID (and other medications) as you need to get your pain down to a reasonable level.