NSAIDs are the post powerful pain relievers known for most conditions.  NSAID stands for "non-steroidal anti-inflammatory drugs."  Unfortunately, they don't treat the underlying condition and can cause side-effects including stomach ulcers, increased blood pressure, kidney damage, etc.  They can both help and cause heart disease.  NSAIDs, like narcotics but to a lesser degree than narcotics, can also cause hyperalgesia.  This means that NSAIDs can in some cases actually cause pain or cause an increase in already existing pain.  When this occurs, it usually occurs after at least several weeks during which an increased dose of the NSAID decreases the pain.  Long-term studies suggest that hyperalgesia from NSAIDs is not a common effect, but it can occur.

NSAIDs can be combined with acetaminophen (generic Tylenol).  This can help hold the total dosage of each down.  There are also many other strategies to reduce pain and hold down NSAID usage.  Probably the most important of these is glucosamine with chondroitin for joint pain.  Vitamin K or bisphosphonates can help bone pain.  Narcotics should always be avoided.

Available NSAIDs and Cost

Brandnamed NSAIDs like Lodine ER are a real rip-off at $2.50 per pill. Mobic and Ponstel are even worse at $3.50 per pill. The best NSAIDs in terms of cost-effectiveness and side-effects are probably the over-the-counter generic ibuprofen (Motrin)($0.02 for 200 mg generic) and naproxen (Naprosyn) ($0.06 for 275 mg generic).  The least expensive prescription NSAID is probably piroxicam at $0.59 since one dose lasts all day ($18/month).  Fenoprofen ($0.30), indomethacin ($0.33 x 3), sulindac ($0.38 x 2) and meclofenamate (0.40) are other lower cost per pill NSAIDs. Arthrotec combines diclofenac 50-75 mg with misoprostol 200 mg to protect the stomach ($2.30), but they cost less if purchased separately ($1.65) and have to be taken twice a day ($95/month).

Prilosec and other proton pump inhibitors can reduce the risk of stomach ulcers from NSAIDs. Melatonin, the sleep aid, and taurine, an amino acid, are two low cost strategies which may also decrease stomach ulcers from NSAIDs, but this conclusion is based on animal research and awaits human studies.  Still, I am a great fan of melatonin and think it worth a try even though the human research hasn't been done.  It has been found to help irritable bowel syndrome in humans. 

Arthrotec (diclofenac and misoprostol) $2.30 each; Diflunisal (Dolobid) 500 mg $1.00 each; also 250 mg; Diclofenac (Voltaren) sodium 50 mg 0.65 each; Etodolac (Lodine) generic 300 mg 0.84 each; also 200, 400, 500 mg and Lodine ER 600 mg $2.50 each; Fenoprofen 600 mg $0.30 each; Flurbiprofen (Ansaid) 100 mg. 0.65 each; Indomethacin (Indocin) 50 mg 0.32 each; t.i.d.; Ketoprofen (Oruvail) $0.50 each; also 25 and 75 mg; Ketorolac (Toradol) 10 mg 0.90 each, t.i.d.; 30 mg/cc IM  2 cc = $12.50; Meclofenamate 50 mg $0.40 each; Mobic (meloxicam) 7.5 mg $3.50 each; Nabumetone (Relafen) 500 mg $1.20 each; Naproxen (Anaprox) 275 mg .50 each prescription; Oxaprozin (Daypro) 600 mg 0.74 each; Piroxicam (Feldene) 20 mg. 0.59 each; also 10 mg. 0.63 each; Ponstel (mefenamic acid) 250 mg $3.30 each; Sulindac (Clinoril) 200 mg bid costs 0.78/day; 150 mg bid 0.70/day; Tolmetin 400 mg 0.83 each; also 200 and 600 mg

Misoprostol costs $0.50 for the 100 mg and $1.00 for the 200 mg size.

Melatonin: Stomach: Protects Against Alendronate Damage: Protective effect of melatonin and omeprazole against alendronate-induced gastric damage in rats. Each did equally well with pretreatment and attributed to anti-oxidant effect. Sener G, et al. Marmara University, Istanbul, Turkey. Dig Dis Sci. 2005 Aug;50(8):1506-12.

Melatonin: Stomach: Melatonin Protects Against Piroxicam, Indomethacin-induced Ulcers: This study with piroxicam in rats. Authors says protection probably true for other NSAIDs. Bandyopadhyay D, et al. Indian Institute of Chemical Biology, Kolkata, India. J Pineal Res. 2004 Apr;36(3):195-203; Similar results against indomethacin ulcers. Singh, et al. Indian J Physiol Pharmacol. 2002 Apr;46(2):229-34.

Melatonin: Stomach: Protects Against Stress-Induced Gastric Ulcers and Helps Ranitidine and Omeprazole: By self did better than ranitidine but not as well as omeprazole in study with rats. D Bandylpadhyay et al. Kolkata, India. J Pineal Res. 2002 Aug;33(1):1-7.

Melatonin: Stomach: Protects Against Alcohol-Induced Ulcers: Bilici et al. Ataturk University. Turkey. Dig Dis Sci. 2002 Apr;47(4):856-61