What We Know About Ibuprofen and NSAIDs — And Why We Should Probably Avoid Relying on Them

Ibuprofen has become so woven into modern life that most of us barely think about taking it.

Bad back after gardening?Headache after a stressful day?Sore knee after a run?Reach for the Ibuprofen.

And to be fair, these medications can work remarkably well. Few drugs reduce pain and inflammation as effectively, as quickly, and as cheaply as NSAIDs (non-steroidal anti-inflammatory drugs).

But there is an uncomfortable truth sitting beneath their everyday familiarity:

These drugs are far more biologically powerful — and potentially disruptive — than most people realise.

As osteopaths, we regularly meet patients who have been taking Ibuprofen for months or even years. Often it started innocently enough: a few tablets here and there for a flare-up. Then gradually it became part of the routine.

The problem is not that NSAIDs are “bad.”The problem is that they are often used without much thought about what they are actually doing inside the body.

And when you look more closely at the science, it becomes difficult to avoid the conclusion that long-term reliance on them is probably not a great strategy for human health.

Your Body Produces Inflammation for a Reason

Modern medicine often talks about inflammation as though it is purely destructive — something to suppress as quickly as possible.

But inflammation is not simply a design flaw.

It is one of the body’s primary repair and protection systems.

When tissue is irritated or injured, the body increases blood flow, activates immune cells, changes local chemistry, and sensitises nerves. This is not random chaos. It is coordinated physiology aimed at protection and repair.

Pain itself is part of this process.

Of course, inflammation can become excessive or persistent, and sometimes reducing it is absolutely appropriate. But the important point is this:

The body is usually doing something for a reason.

So What Does Ibuprofen Actually Do?

Ibuprofen works by blocking enzymes called COX-1 and COX-2, which help produce prostaglandins — signalling molecules involved in pain and inflammation.

Reduce prostaglandins, and pain often decreases.

Simple enough.

Except prostaglandins are also involved in:

• protecting the stomach lining

• regulating kidney blood flow

• maintaining cardiovascular stability

• supporting tissue healing

• regulating clotting and vascular function

This is the part many people never hear about.

Ibuprofen is not acting only on your sore shoulder or irritated back. It is altering chemistry throughout the entire body.

And this is precisely why the side effects are not random accidents. They are predictable consequences of interfering with systems the body relies upon.

The Gut Problems Are Extremely Well Established

The gastrointestinal risks of NSAIDs are among the clearest findings in medical research.

Regular NSAID use is associated with increased risk of:

• gastritis

• stomach ulcers

• reflux

• intestinal irritation

• gastrointestinal bleeding

Sometimes these complications are dramatic. More often they develop quietly over time.

One of the more concerning realities is that many people take NSAIDs chronically while assuming that the absence of symptoms means the absence of harm.

Unfortunately, that is not always true.

A major review published in Therapeutic Advances in Drug Safety highlighted the substantial gastrointestinal risks associated with long-term NSAID use, particularly in older adults.

The Cardiovascular Concerns Are Harder to Ignore Now

For years, NSAIDs were mainly thought of as “stomach irritants.”

But over the past two decades, cardiovascular research has changed the conversation significantly.

Evidence now links NSAID use with increased risk of:

• elevated blood pressure

• fluid retention

• heart attack

• stroke

• worsening heart failure

This became especially apparent after the withdrawal of the drug Vioxx, but the issue extends beyond one medication.

Even common over-the-counter NSAIDs like Ibuprofen are not entirely benign from a cardiovascular perspective.

A large study published in the BMJ found increased risk of acute myocardial infarction associated with NSAID use, even during relatively short periods of treatment.

The Kidney Effects Deserve More Attention

The kidneys depend on healthy blood flow to function properly, and prostaglandins help regulate this delicate balance.

NSAIDs interfere with these mechanisms.

In healthy young individuals taking occasional doses, this may not matter much. But in older adults, dehydrated individuals, athletes, or people with underlying health issues, the effects can become clinically significant.

Potential consequences include:

• impaired kidney function

• fluid retention

• elevated blood pressure

• acute kidney injury

This is one reason NSAID use in endurance sport and heavy training environments has become increasingly controversial.

A review in BMC Nephrology discussed the association between NSAID use and acute kidney injury, particularly in higher-risk populations.

Painkillers Can Sometimes Delay Recovery

This is where things become especially interesting from a musculoskeletal perspective.

Inflammation is not merely irritation — it is also part of tissue healing.

Prostaglandins help regulate collagen synthesis, blood flow, and tissue repair. Some research suggests that suppressing these pathways aggressively may impair aspects of healing in muscles, tendons, ligaments, and even bone.

This is particularly relevant in people who repeatedly use NSAIDs to “push through” training, work, or physical stress.

Pain is not always a message to stop completely. But neither is it usually wise to simply silence it repeatedly without understanding why it keeps appearing.

A Different Way of Looking at Pain

At Bicester Osteopathy, we are interested not only in where pain hurts, but why the body is producing it in the first place.

Very often persistent pain reflects:

• reduced movement variability

• stiffness and compensation

• overload

• poor recovery

• sedentary habits

• chronic tension

• loss of strength or mobility

• nervous system sensitisation

This is where osteopathy can play an important role.

Using classical osteopathy and total body adjustment, we aim to improve how the body functions as an integrated system rather than simply chasing symptoms from one area to another.

Treatment may help:

• improve joint mobility

• reduce excessive muscular tension

• restore more balanced movement patterns

• improve circulation and tissue mechanics

• reduce unnecessary strain on irritated structures

• improve postural adaptability

• support the nervous system’s ability to regulate tension and pain

Often, when the body moves better and functions better, pain reduces naturally — without needing to constantly override it chemically.

Supporting the Body Rather Than Fighting It

For many musculoskeletal problems, long-term improvement usually comes from improving the environment the body is operating within.

That may include:

• regular movement

• walking

• strength training

• mobility work

• better sleep

• stress reduction

• pacing and recovery

• reducing prolonged sitting

• improving general physical resilience

These approaches are admittedly less glamorous than taking a tablet.

But they are often far more effective over the long term.

So Should We Be Taking Ibuprofen?

No! ;-)

Ideally not in the first 48 hours after injury.

Preferably never!

There are perhaps situations where NSAIDs can be useful and appropriate, but long-term reliance on suppressing symptoms may come at a physiological cost — and often distracts from addressing why the problem developed in the first place.

Pain is not always the enemy.

Sometimes it is simply information.

And perhaps one of the most important things modern healthcare can do is help people understand what their body is trying to say — rather than merely silencing it.

References

1. Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017.

2. Bally M et al. Risk of acute myocardial infarction with NSAIDs. BMJ. 2017.

3. Dreischulte T et al. NSAID use and risk of acute kidney injury. CMAJ. 2015.

4. Bjarnason I et al. Side effects of nonsteroidal anti-inflammatory drugs on the small and large intestine. Gastroenterology. 2018.

5. Ungprasert P et al. Non-steroidal anti-inflammatory drugs and risk of heart failure. European Journal of Internal Medicine. 2016.