Pain relief: 3 natural alternatives to ibuprofen

If your bathroom cabinet is anything like ours, it likely contains a box of ibuprofen. It’s on hand to relieve a headache, back pain, period pain or to speed up the recovery from a cold or flu. But we probably hadn’t considered that these popular painkillers may be prolonging our pain. New evidence suggests it may be doing exactly that. If that’s the case, what could be a safe alternative to this bathroom cabinet staple?

A short history of ibuprofen

Ibuprofen was first developed in the 1950s by UK pharmacist Boots. Although initially intended as a treatment for rheumatoid arthritis, by the 1980s, it was more commonly being used to relieve mild to moderate muscular aches and pains. By the 1990s, it was available for purchase off the shelf, without the supervision of a pharmacist.

Our increasing dependence on ibuprofen

Ibuprofen, along with naproxen and diclofenac, is classified as a nonsteroidal anti-inflammatory drug (NSAID). In 2019, global sales of NSAIDs reached £77 billion. With sales projected to rise to £158 billion by 2027, our faith in these drugs shows no sign of abating anytime soon.

Like me, you’ve no doubt had your reservations about using these drugs as well as opioids, such as codeine, dihydrocodeine, and tramadol, after reading about the dangers of addiction and the many unwanted side effects. [1]

Ibuprofen likely causes chronic pain

To compound these dangers, a 2022 study has suggested that, despite their potential short-term painkilling benefits, NSAIDs like ibuprofen more than likely turn short-term (acute) pain into long-term (chronic) pain by blocking the inflammation and repair process. [2]

One aspect of the study was to analyse data from the UK Biobank, a biomedical database of 500,000 UK participants. This showed that those in the database who took anti-inflammatories such as ibuprofen for pain were more likely to still be in pain two to 10 years later.

It appears absurd to comprehend that ibuprofen likely turns acute pain into chronic pain. Especially so, when set against the backdrop of the number of people struggling with chronic pain like fibromyalgia, chronic fatigue, IBS, arthritis, back pain and migraines.

The British Pain Society refers to this as “the silent epidemic” after research they commissioned in 2016 found that more than two-fifths of the UK population were affected by chronic pain. That’s around 28 million people. [3]

Is ibuprofen part of the problem, not the solution?

Let us put those three things together: 

• our increasing use of ibuprofen
• ibuprofen likely causes chronic pain
• we are in the midst of a chronic pain epidemic 

I’m not a neuroscientist but, as a clinical massage therapist, I’m able to witness exactly how impactful and complex chronic pain can be. From a client with chronic migraines, stemming from a 20-year-old car accident, exacerbated by stress and anxiety to a client with a frozen shoulder, originating from an overuse injury 12 years ago, again triggered by stressful events.

Even my own chronic low back pain reminds me of how many factors can trigger it, like putting on a bit of weight to neglecting my stretching routine. So, to see ibuprofen being moved from the helpful list to the aggravator list is a bit of a concern.

Is all inflammation bad?

Inflammation gets a bad wrap, but there is an important difference between acute inflammation (which is a critically essential phase in the regeneration and repair of damaged tissue) and chronic inflammation - more on that in a bit.

Acute inflammation usually lasts between five to seven days and is recognisable by one or more of the following classic signs:

• pain
• swelling
• redness
• warmth
• impaired function

During the repair process, a complex interplay occurs between different cells, proteins, and the circulatory system. The inflammation helps to create new blood cells, protect the damaged tissue, and promote the generation of new tissue.

Whatsmore, the presence or absence of inflammation sends signals to the brain telling it to either continue the healing process (create more inflammation) or that the job is done and to return the tissue to its normal state. [4]

What about chronic inflammation?

Chronic inflammation persists in some parts due to messaging not getting to the brain and spinal cord where pain sensation is created. Neutrophils, a type of white blood cell responsible for fighting infection become overexuberant, sending the wrong signals to the brain and spinal cord, resulting in more inflammation being created. [4, 5]

Significantly, the 2022 study into NSAIDs, which was reported in the Guardian found that drugs like ibuprofen blocked these same neutrophils, in turn prolonging pain by up to 10 times.

What are natural alternatives to ibuprofen?

Let our body do what it is designed to do

For acute injuries like minor sprains and strains, it is best to protect the injury, elevate it above the heart if possible, avoid anti-inflammatories, and allow the body to heal itself. [6]

According to Dr Howard Schubinar - a clinician and author renowned for his work on resolving chronic pain, and recently interviewed on Dr Rangan Chatterjee’s podcast - pain is our body’s way of saying it is not happy with something. This could relate to tissue damage but more often relates to stress, anxiety, trauma, and past pain experiences.

Our bodies are designed to heal and we can aid that healing process by understanding which factors may be affecting our pain and making changes to aid healing.

Self-healing can be improved by calming the nervous system through relaxation techniques, regulating stress, mindfulness, and massage. [7, 8, 9] For chronic pain, I recommend building a toolkit of the things you find helpful. Try out things that are likely to calm the nervous system. If it helps, keep it. If it doesn’t, ditch it. Here are a few things to try:

1. Breathing techniques

Diaphragmatic breathing calms the nervous system and has been shown to reduce stress, one of the aggravators of chronic pain. [10]

If you want to give it a go, check out these five breathing techniques to manage stress.

2. Mindfulness meditation

The ancient practice of meditation has been evidenced to show its effectiveness in the effective treatment of chronic pain. [11]

Find out more about how to reduce stress through meditation.

3. Remedial massage

Massage can be particularly effective at reducing chronic musculoskeletal pain. [12, 13, 14]

It is key that the massage is not painful or aggravating, so good communication and trust with the therapist are essential. Ideally, find a well-qualified therapist who has experience in working with chronic pain. 

You could search for Jing Method therapists similar to myself with a BTEC Level 6 Diploma in advanced clinical and sports massage, or search the Therapy Directory for verified massage therapists.

References

1. Neuman MD, Bateman BT, Wunsch H. Inappropriate opioid prescription after surgery. The Lancet. 2019;393(10180):1547-1557. doi:10.1016/S0140-6736(19)30428-3

2. Parisien M, Lima LV, Dagostino C, et al. Acute inflammatory response via neutrophil activation protects against the development of chronic pain. Science Translational Medicine. 2022;14(644). doi:10.1126/scitranslmed.abj9954

3. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. 2016;6(6):e010364. doi:10.1136/bmjopen-2015-010364

4. Cooke JP. Inflammation and Its Role in Regeneration and Repair. Circulation Research. 2019;124(8):1166-1168. doi:10.1161/circresaha.118.314669

5. Castanheira FVS, Kubes P. Neutrophils and NETs in modulating acute and chronic inflammation. Blood. 2019;133(20):2178-2185. doi:10.1182/blood-2018-11-844530

6. Dubois B, Esculier JF. Soft-tissue Injuries Simply Need PEACE and LOVE. British Journal of Sports Medicine. 2019;54(2):bjsports-2019-101253. doi:10.1136/bjsports-2019-101253

7. Cherkin DC, Sherman KJ, Kahn J, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Annals of internal medicine. 2011;155(1):1-9. doi:10.7326/0003-4819-155-1-201107050-00002

8. Chu KH, Tung HH, Clinciu DL, et al. A Preliminary Study on Self-Healing and Self-Health Management in Older Adults: Perspectives From Healthcare Professionals and Older Adults in Taiwan. Gerontology and Geriatric Medicine. 2022;8:233372142210777. doi:10.1177/23337214221077788

9. Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database of Systematic Reviews. 2015;2015(9). doi:10.1002/14651858.cd001929.pub3

10. Hopper SI, Murray SL, Ferrara LR, Singleton JK. Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults. JBI Database of Systematic Reviews and Implementation Reports. 2019;17(9):1855-1876. doi:10.11124/jbisrir-2017-003848

11. Kabat-Zinn J, Lipworth L, Burney R. The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine. 1985;8(2):163-190. doi:10.1007/bf00845519

12. Hernandez-reif M, Field T, Krasnegor J, Theakston H. Lower Back Pain is Reduced and Range of Motion Increased After Massage Therapy. International Journal of Neuroscience. 2001;106(3-4):131-145. doi:10.3109/00207450109149744

13. Keeratitanont K, Jensen MP, Chatchawan U, Auvichayapat P. The efficacy of traditional Thai massage for the treatment of chronic pain: A systematic review. Complementary Therapies in Clinical Practice. 2015;21(1):26-32. doi:10.1016/j.ctcp.2015.01.006

14. Walach H, Güthlin C, König M. Efficacy of Massage Therapy in Chronic Pain: A Pragmatic Randomized Trial. The Journal of Alternative and Complementary Medicine. 2003;9(6):837-846. doi:10.1089/107555303771952181