Do You Actually Need to Avoid NSAIDs if You Have Crohn’s Disease?

Why Are People With Crohn’s Disease Told to Avoid NSAIDs?

“NSAIDs block certain enzymes in the gut lining, called cyclooxygenase (COX) enzymes,” says Tauseef Ali, MD, the medical executive director at SSM Health St. Anthony Digestive Care and the director of the Crohn’s and Colitis Center in Oklahoma City, Oklahoma. “This [also] lowers the levels of protective prostaglandins that help keep the gut lining healthy.”

“The American College of Gastroenterology guidelines for Crohn’s disease advise against NSAID use as they ‘may exacerbate disease activity and routine use should be viewed with caution,’” says Andrew DuPont, MD, a gastroenterologist with UT Health Houston and a professor of gastroenterology, hepatology, and nutrition at McGovern Medical School in Houston. “However, this guidance is generally based on small studies,” says Dr. DuPont.

What Are the Risks of NSAIDs for People With Crohn’s?

• Stomach ulcers
• Bleeding in the digestive tract
• Kidney problems (especially with dehydration)

“Because of these risks, most gastroenterologists suggest avoiding regular NSAID use in people with IBD if there are other options,” says Ali. But while some studies have found a link between NSAID use and worsening IBD, the evidence is not always clear, he says.

Do People With Crohn’s Actually Need to Avoid NSAIDs?

But they may give you the green light for a short time, says Dr. Parian. The risks of an IBD flare decrease when you take lower NSAID doses for shorter periods, she says.

Taking NSAIDs with Crohn’s disease should be considered on a case-by-case basis, weighing complications of the disease against any history of severe flares, says DuPont.

How to Manage Pain With Crohn’s Disease

Both Ali and Parian sometimes recommend other treatments to their patients, depending on the cause of pain.

• Physical therapy or creams for muscle or joint pain
• Antispasmodics for cramping
• Antidepressants, which act as neuromodulators for chronic pain
• Antiseizure medications for nerve-related pain
• Psychological therapies like cognitive behavioral therapy, mindfulness, or gut-focused therapy for coping with chronic pain

Sometimes, a pain specialist can help, says Ali. “Long-term use of opioids should be avoided whenever possible, since it can lead to more hospital stays, infections, narcotic bowel syndrome, and a lower quality of life in people with IBD,” he says.

If you need to take an NSAID, your provider may recommend a type called a COX-2 inhibitor, which may be safer for the gut, says Parian. “It's important to remember that IBD is a complex and chronic condition that requires a personalized approach to treatment,” she says. “What works for one person may not work for another.”

Work closely with your gastroenterologist to develop a pain management plan tailored to your specific needs and circumstances, says Parian. “This plan should encompass not only medication but also diet, lifestyle, and mental health support,” she says.