I’m a Clinical Pharmacist, and I Was Wrong About Ibuprofen. Here’s the Hidden Truth About How It Causes Constipation.

As a clinical pharmacist, I’ve spent thousands of hours counseling patients on the safe use of medications. I thought I had the script for ibuprofen down cold. So, when my own father, who took it daily for his arthritis, started complaining of persistent constipation, I recited the standard lines. “Dad, that’s highly unlikely,” I’d say, pulling up the data in my head. “Ibuprofen is much more likely to cause heartburn or diarrhea. Constipation is the hallmark of opioids, not NSAIDs like ibuprofen.”

I advised him to drink more water, add some fiber to his diet, and get more exercise. But his problem didn’t just persist; it worsened. It wasn’t a minor inconvenience; it was a debilitating issue that was seriously affecting his quality of life. His frustration, and my inability to solve it with textbook answers, forced me to confront a humbling possibility: what if my professional certainty was a blind spot?

That question sent me on a deep dive, not just into side effect profiles, but into the fundamental way ibuprofen works in the body. What I discovered was a profound realization that the way we typically frame ibuprofen’s side effects is incomplete. We focus on the most common symptoms while ignoring a deeper, systemic disruption. This journey revealed the hidden mechanism by which ibuprofen can and does cause constipation. It’s a story about the unsung heroes of our gut and how a common pain reliever can inadvertently throw their entire system into chaos.

The Conventional Wisdom vs. The Deeper Truth

It’s no surprise that the link between ibuprofen and constipation is often overlooked, even by healthcare professionals. The statistical reality is that other gastrointestinal (GI) side effects are far more common. Data shows that while constipation may affect between 1% and 10% of patients, issues like nausea (up to 57%), vomiting (up to 22%), gas (16%), and diarrhea (10%) are significantly more frequent.¹ This statistical hierarchy naturally pushes constipation down the list of concerns for both clinicians and patients.

Furthermore, the entire conversation around medication-induced constipation is overwhelmingly dominated by opioids like morphine and oxycodone. Opioid-Induced Constipation (OIC) is such a severe, well-documented, and common side effect that it casts a long shadow over other potential culprits.¹ This creates a cognitive bias; when a patient on multiple medications develops constipation, the opioid is almost always the first suspect, while an NSAID like ibuprofen is often dismissed.

Yet, despite being less frequent, the connection is medically established and consistently reported. Major health authorities, including the UK’s National Health Service (NHS), MedlinePlus, and Drugs.com, all list constipation as a known side effect of ibuprofen.⁴

More compellingly, a large cross-sectional study published in BMC Gastroenterology moved beyond simple listings and found a statistically significant association. The study reported a constipation prevalence of 19.4% among ibuprofen users compared to just 13.3% in non-users.⁸ The researchers went a step further, calculating an “excess drug-related prevalence” of 5.3%. This figure suggests that for every 100 people who start taking ibuprofen, more than five will develop constipation they wouldn’t have had otherwise.⁸

This reveals a critical distinction in how we perceive side effects. Nausea and heartburn are acute and immediate—you take a pill, and your stomach hurts. The cause-and-effect relationship is clear. Constipation, however, is a slower, more insidious process. It develops over days and can be easily misattributed to other common factors like a change in diet, a stressful week, or not drinking enough water.⁹ It exists in a clinical blind spot: not common enough to be the primary warning, but significant enough to affect millions of users who are then left to puzzle over the cause of their discomfort.

The Epiphany: Uncovering the Gut’s Master Regulator

My “aha” moment in trying to solve my father’s problem didn’t come from a list of side effects. It came from revisiting the most basic question: how does ibuprofen actually work? The answer lies not with the drug itself, but with a group of compounds it targets: prostaglandins.

Prostaglandins are powerful, hormone-like lipid compounds that are produced in virtually every cell of the body.¹¹ They aren’t traditional hormones that travel from a gland through the bloodstream. Instead, they are local chemical messengers, acting as an on-site maintenance and emergency response crew for the very tissues that create them.¹¹ Ibuprofen and other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) provide relief from pain and inflammation by blocking enzymes called cyclooxygenase (COX-1 and COX-2). These enzymes are the “factories” that convert a fatty acid (arachidonic acid) into prostaglandins.¹⁴

By shutting down these factories to stop pain signals, ibuprofen also shuts down all the other vital, everyday jobs that prostaglandins perform. To understand the collateral damage, it helps to use an analogy.

Think of your digestive system as a complex highway network. Prostaglandins are the Highway Maintenance Crew. This crew has three critical, simultaneous jobs:

1. Paving & Repair (Protection): They constantly patch and resurface the highway (your stomach and intestinal lining) to protect it from damage.
2. Traffic Control (Motility): They operate the synchronized traffic lights that regulate the speed and flow of traffic (the movement of food through your gut).
3. Roadside Drainage (Fluid Balance): They manage water and fluid levels to keep the road surface optimal for smooth travel.

Taking ibuprofen to relieve pain is like firing the entire highway maintenance crew just to stop one noisy construction project. The immediate problem of pain might be solved, but now the highway system is headed for a crisis.

A System in Crisis: The Three Ways Ibuprofen Disrupts Your Digestion

Using our highway analogy, we can see that ibuprofen doesn’t just cause one problem; it launches a three-pronged attack on the systems that keep your digestion running smoothly.

Disruption 1: Snarled Traffic (Impaired Motility)

The rhythmic, wave-like contractions that propel food through your intestines, known as peristalsis, are not random. They are orchestrated by specialized “pacemaker” cells called the Interstitial Cells of Cajal (ICC).¹⁷ These cells generate the electrical “slow waves” that are, in effect, the synchronized traffic light system for your gut. Prostaglandins are the master technicians who ensure this system runs perfectly, regulating the frequency and strength of these waves.¹⁷

When ibuprofen inhibits prostaglandin production, it’s like a city-wide power outage hitting the traffic grid. The signals become weak, uncoordinated, and less frequent.¹⁸ This leads directly to the primary symptoms of constipation: stool moves more slowly, bowel movements become infrequent, and you may experience bloating and a feeling of fullness or incomplete evacuation.⁹

This reframes the issue entirely. Ibuprofen-induced constipation isn’t typically a physical “blockage” like too much dry fiber. It’s a state of functional dysmotility. The propulsive force itself has been compromised. This explains why simply drinking more water or adding a little fiber—while helpful—might not be enough to solve the problem for some people. The “traffic” is still on the highway, but the system designed to move it along is failing.

Disruption 2: Crumbling Roads (Compromised Defenses)

Prostaglandins are famous in gastroenterology for their “cytoprotective” role, which is the “Paving & Repair” function of our maintenance crew.¹⁵ They stimulate the secretion of a protective mucus and bicarbonate layer that shields the stomach and intestinal lining from being damaged by its own acid and other irritants.²²

When ibuprofen fires this crew, the protective lining thins and weakens. The highway surface begins to crumble. This is precisely why NSAIDs are infamous for causing gastritis (stomach inflammation), erosions, and even peptic ulcers.¹⁴ This chemical-induced irritation and inflammation in the gut lining further disrupts normal function, contributing to the overall digestive slowdown and discomfort.

This can create a vicious cycle. A drug taken to reduce inflammation in an arthritic knee can inadvertently cause low-grade inflammation in the gut. This new gut inflammation then worsens the very dysmotility that’s causing the constipation, creating a self-perpetuating problem.

Disruption 3: Failing Drainage (Altered Fluid Balance)

The final job of our maintenance crew is managing the “Roadside Drainage.” Prostaglandins play a role in regulating the secretion of water and electrolytes into the intestines.²⁷ This process is crucial for keeping stool soft and easy to pass.

By inhibiting prostaglandins, ibuprofen can disrupt this delicate fluid balance. The gut may secrete less fluid into the stool. Compounding this, because the stool is already moving more slowly due to impaired motility, it sits in the colon for longer. This gives the colon more time to do its job of reabsorbing water back into the body.¹⁰ The combination of less fluid secretion and more fluid reabsorption results in harder, drier, and more difficult-to-pass stool.

Quantifying the Risk: Prevalence, Statistics, and Personal Factors

The risk of developing constipation from ibuprofen is real, but it’s not the same for everyone. While some sources cite a frequency of 1% to 10%, the larger population study finding a 19.4% prevalence in users suggests the problem may be more common than widely reported, especially among those who use it regularly.¹

To put this in perspective, it’s helpful to see how constipation stacks up against other GI side effects.

Side Effect	Reported Frequency Range	Source(s)
Nausea	Up to 57%	1
Vomiting	Up to 22%	1
Flatulence / Gas	Up to 16%	1
Diarrhea	Up to 10%	1
Heartburn / Stomach Pain	1% to 10%	1
Constipation	1% to 10%	1

Several factors can increase your personal risk of experiencing this side effect:

• Age: Adults over 60-65 are more susceptible to all NSAID-related GI complications. This is due to natural changes in gut function, a higher likelihood of having other risk factors, and potentially reduced kidney function affecting how the drug is cleared.²⁸
• Dosage and Duration: The risk is dose-dependent. Taking a high dose for a long period (e.g., daily for chronic arthritis) carries a much greater risk than taking a single, low dose for a headache.³
• Polypharmacy (Taking Multiple Medications): Your risk increases if you are also taking other medications known to cause constipation. This includes some antidepressants, blood pressure drugs (especially calcium channel blockers), iron supplements, and of course, opioids.⁸
• Underlying Conditions: If you have a history of GI issues like Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease (IBD) like Crohn’s or ulcerative colitis, or a history of peptic ulcers, your gut is already more vulnerable to disruption.²³
• Lifestyle Factors: A baseline of poor hydration, a low-fiber diet, and a sedentary lifestyle can create sluggish digestion. When you add a motility-disrupting drug like ibuprofen to this system, it’s more likely to tip the scales toward constipation.¹

A Holistic Management Protocol: Rebuilding the Gut’s Support Systems

You cannot fix a systemic problem with a single-point solution. Since ibuprofen disrupts motility, protection, and fluid balance, an effective strategy must support all three systems. Think of it as hiring new, specialized crews to counteract the damage.

Level 1: Foundational Support (Counteracting Fluid Imbalance & Aiding Motility)

This is the non-negotiable first line of defense.

• Aggressive Hydration: Aim for at least 8-10 glasses (2-2.5 liters) of water and other non-caffeinated fluids per day. This directly combats the stool-drying effect of slowed transit.³³
• Strategic Fiber Intake: Fiber is crucial, but the type matters. Focus on a mix of soluble fiber (oats, apples, beans, psyllium) which forms a gel and softens stool, and insoluble fiber (whole grains, nuts, broccoli) which adds bulk to stimulate movement. Introduce fiber slowly to allow your system to adapt and avoid gas and bloating.¹
• Movement is Medicine: Regular physical activity, even a brisk 30-minute walk, is a powerful natural stimulant for gut motility. It helps counteract the drug-induced slowdown.³³

Category	Excellent Choices	Notes
High-Fiber Fruits	Prunes, pears, apples (with skin), berries, kiwifruit	Prunes and pears are particularly effective due to their sorbitol content, a natural laxative.36
High-Fiber Vegetables	Broccoli, carrots, leafy greens (spinach, kale), green peas	Aim for a variety of colorful vegetables at every meal.
High-Fiber Legumes	Lentils, black beans, chickpeas, kidney beans	Excellent sources of both soluble and insoluble fiber.
High-Fiber Grains	Oatmeal, bran cereals, whole-wheat bread and pasta	Choose “whole grain” or “whole wheat” as the first ingredient.
Hydration Plan	Water, herbal teas, clear soups	Aim for 2-2.5 liters daily. Drink a full glass of water with any fiber supplement.

Level 2: Gentle Assistance (Over-the-Counter Aids)

If foundational support isn’t enough, these are the next logical steps.

• Stool Softeners (e.g., docusate): These are a good starting point. They don’t force a bowel movement but work by allowing more water to be absorbed into the stool, making it softer and easier to pass. This directly counteracts the “failing drainage” mechanism.¹
• Osmotic Laxatives (e.g., polyethylene glycol 3350, lactulose): These work by drawing more water into the colon from the surrounding tissues. This softens the stool and can provide a gentle stimulus for movement. They are generally considered safe for regular use if needed.³⁷

Level 3: Escalated Intervention (Use With Caution & Consultation)

These are for short-term relief, not long-term management.

• Stimulant Laxatives (e.g., senna, bisacodyl): These directly stimulate the nerves in the colon to induce contractions. They are a direct intervention for the “snarled traffic” problem. However, the bowel can become dependent on them with chronic use, so they are best reserved for occasional, short-term relief.³⁷
• The Crucial Caveat: Always consult a doctor or pharmacist before starting any laxative regimen, especially if constipation is new, severe, or lasts more than a week. It is vital to rule out other underlying medical conditions.¹

Level 4: Professional Gut Protection (Counteracting a Crumbling Road)

For individuals on long-term, high-dose NSAID therapy (e.g., for chronic arthritis), a doctor may prescribe a medication to protect the gut lining.

• Proton Pump Inhibitors (PPIs) (e.g., omeprazole): These drugs reduce stomach acid production, helping to protect the gut from damage and preventing the “vicious cycle of inflammation.” This is a proactive strategy to protect the gut’s infrastructure from the start.¹⁴

Navigating Alternatives: A Pharmacist’s Guide to Other Pain Relievers

The ultimate goal is to find effective pain relief without firing the gut’s essential maintenance crew. Here are the primary alternatives to discuss with your doctor.

Alternative 1: Acetaminophen

• How it Works: Acetaminophen is NOT an NSAID. It is thought to work primarily in the brain and spinal cord to block pain signals and has very little effect on prostaglandin production in the rest of the body.⁴⁰
• Pros: Because it doesn’t significantly inhibit peripheral prostaglandins, it is much gentler on the stomach lining and does not carry the same risk of ulcers or motility disruption.³²
• Cons: It is not an anti-inflammatory, making it less effective for pain driven by significant swelling (like acute sprains or inflammatory arthritis).⁴⁰ The main risk is severe liver damage if the maximum daily dose is exceeded or if taken with alcohol.⁴⁰

Alternative 2: Topical NSAIDs (Gels, Creams, Patches)

• How it Works: These products deliver an NSAID (like diclofenac or ibuprofen) directly through the skin to the site of pain, such as a sore knee or elbow.⁴³
• Pros: This provides localized pain and inflammation relief with much lower absorption into the bloodstream. By keeping the drug’s action local, it largely avoids the systemic shutdown of prostaglandins, thus sparing the gut’s maintenance crew.²³
• Cons: It is only effective for localized pain in joints or muscles close to the skin’s surface. It is not useful for systemic pain like a headache or widespread body aches.

Alternative 3: Non-Drug Modalities

For many types of pain, especially chronic pain, a multi-faceted approach is best. Evidence-based, non-pharmacological therapies can complement or sometimes even replace medication. These include physical therapy, heat and cold application, massage, acupuncture, and stress-management techniques like meditation.⁴³

Medication	How It Works	Best For…	Primary Constipation Risk	Key Consideration
Oral Ibuprofen	Systemic prostaglandin inhibition	Inflammatory pain (arthritis, sprains), fever, body aches	Moderate: Disrupts motility, protection, and fluid balance	Risk of stomach ulcers and bleeding; kidney effects with long-term use.
Acetaminophen	Central pain signal blocking	Mild-to-moderate pain (headaches, osteoarthritis), fever	Low: Does not significantly impact gut prostaglandins	Not an anti-inflammatory; risk of liver damage at high doses or with alcohol.
Topical NSAID	Localized prostaglandin inhibition	Localized joint/muscle pain (e.g., knee arthritis, tendinitis)	Very Low: Minimal systemic absorption spares the gut	Only effective for pain in a specific, localized area.

Conclusion: A New Framework for Understanding Your Medication

Returning to my father’s story, this new understanding changed everything. We shifted our approach from simply trying to “fix” his constipation to proactively supporting his digestive system against the effects of his medication. We implemented a holistic plan: aggressive hydration, a strategic increase in dietary fiber, and switching his daily pain management from an oral pill to a topical NSAID gel for his arthritic knee. He now uses oral ibuprofen only for occasional, severe flare-ups. The result? His chronic constipation resolved, and his overall quality of life improved dramatically.

The experience taught me a valuable lesson that extends beyond any single drug. The most powerful tool you have in managing your health is not a specific pill, but a true understanding of why your body is reacting the way it is. By looking past the surface-level symptoms to the underlying mechanism—the shutdown of the gut’s master maintenance crew—you can move from simply reacting to side effects to proactively supporting your body’s intricate systems.

Listen to your body. If conventional wisdom doesn’t match your experience, don’t be afraid to question it. Use this knowledge to be your own best advocate and to have more informed, productive conversations with your doctors and pharmacists. You have the power to move beyond just treating symptoms and toward a deeper understanding of your own health.

Works cited

1. Can ibuprofen cause constipation? – Drugs.com, accessed on August 9, 2025, https://www.drugs.com/medical-answers/ibuprofen-constipation-3572103/
2. Painkillers causing constipation and digestive symptoms – Guts UK, accessed on August 9, 2025, https://gutscharity.org.uk/advice-and-information/symptoms/opioid-induced-bowel-dysfunction/
3. 9 Medications That Can Cause Constipation – Verywell Health, accessed on August 9, 2025, https://www.verywellhealth.com/can-medication-cause-constipation-11705724
4. Ibuprofen: MedlinePlus Drug Information, accessed on August 9, 2025, https://medlineplus.gov/druginfo/meds/a682159.html
5. ibuprofen 800 mg tablet – Kaiser Permanente, accessed on August 9, 2025, https://healthy.kaiserpermanente.org/health-wellness/drug-encyclopedia/drug.ibuprofen-800-mg-tablet.173420
6. Ibuprofen – NHS inform, accessed on August 9, 2025, https://www.nhsinform.scot/tests-and-treatments/medicines-and-medical-aids/types-of-medicine/ibuprofen/
7. Side effects of ibuprofen – NHS, accessed on August 9, 2025, https://www.nhs.uk/medicines/ibuprofen-for-adults/side-effects-of-ibuprofen/
8. Constipation and diarrhoea – common adverse drug reactions? A …, accessed on August 9, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC3049147/
9. Constipation – NHS inform, accessed on August 9, 2025, https://www.nhsinform.scot/illnesses-and-conditions/stomach-liver-and-gastrointestinal-tract/constipation/
10. Constipation – Symptoms and causes – Mayo Clinic, accessed on August 9, 2025, https://www.mayoclinic.org/diseases-conditions/constipation/symptoms-causes/syc-20354253
11. Prostaglandins – Chemistry LibreTexts, accessed on August 9, 2025, https://chem.libretexts.org/Bookshelves/Biological_Chemistry/Supplemental_Modules_(Biological_Chemistry)/Lipids/Fatty_Acids/Prostaglandins
12. Prostaglandins: What It Is, Function & Side Effects – Cleveland Clinic, accessed on August 9, 2025, https://my.clevelandclinic.org/health/articles/24411-prostaglandins
13. Prostaglandin | Definition, Function, Synthesis, & Facts – Britannica, accessed on August 9, 2025, https://www.britannica.com/science/prostaglandin
14. Preventing GI Damage from NSAIDs – badgut.org, accessed on August 9, 2025, https://badgut.org/information-centre/a-z-digestive-topics/preventing-gi-damage-nsaids/
15. NSAIDs: Good for the Joints, Bad for the Gut? – IFFGD, accessed on August 9, 2025, https://iffgd.org/manage-your-health/diet-and-treatments/nsaids/
16. Prostaglandin inhibitors – Wikipedia, accessed on August 9, 2025, https://en.wikipedia.org/wiki/Prostaglandin_inhibitors
17. Prostaglandin regulation of gastric slow waves and peristalsis – PMC, accessed on August 9, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC2697952/
18. The Role of Prostaglandins in Disrupted Gastric Motor Activity Associated With Type 2 Diabetes, accessed on August 9, 2025, https://diabetesjournals.org/diabetes/article/68/3/637/39816/The-Role-of-Prostaglandins-in-Disrupted-Gastric
19. Role of prostaglandins in regulating gastric motility – PubMed, accessed on August 9, 2025, https://pubmed.ncbi.nlm.nih.gov/6589963/
20. Ibuprofen Side Effects: Common, Severe, Long Term – Drugs.com, accessed on August 9, 2025, https://www.drugs.com/sfx/ibuprofen-side-effects.html
21. Non-steroidal anti-inflammatory drugs and the gastrointestinal tract – PMC, accessed on August 9, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC8002800/
22. 15 Ibuprofen (Advil) Side Effects: Heartburn, Internal Bleeding & More, accessed on August 9, 2025, https://www.healthline.com/health/pain-relief/ibuprofen-advil-side-effects
23. NSAIDs Can Wreck Your Stomach If You’re Not Careful: Are You at Risk? – CreakyJoints, accessed on August 9, 2025, https://creakyjoints.org/living-with-arthritis/treatment-and-care/medications/nsaids-gastrointestinal-side-effects/
24. Role of endogenous prostaglandins in gastric secretion and mucosal defense – PubMed, accessed on August 9, 2025, https://pubmed.ncbi.nlm.nih.gov/3040310/
25. NSAID Gastropathy – Physiopedia, accessed on August 9, 2025, https://www.physio-pedia.com/NSAID_Gastropathy
26. Reducing Side Effects of NSAIDs Like Ibuprofen and Naproxen – HSS, accessed on August 9, 2025, https://www.hss.edu/health-library/conditions-and-treatments/guidelines-reduce-side-effects-nsaids
27. Prostaglandins and gastrointestinal function – PubMed, accessed on August 9, 2025, https://pubmed.ncbi.nlm.nih.gov/742550/
28. Ibuprofen (oral route) – Side effects & dosage – Mayo Clinic, accessed on August 9, 2025, https://www.mayoclinic.org/drugs-supplements/ibuprofen-oral-route/description/drg-20070602
29. Who can and cannot take or use ibuprofen – NHS, accessed on August 9, 2025, https://www.nhs.uk/medicines/ibuprofen-for-adults/who-can-and-cannot-take-ibuprofen/
30. Ibuprofen and acetaminophen (oral route) – Side effects & dosage – Mayo Clinic, accessed on August 9, 2025, https://www.mayoclinic.org/drugs-supplements/ibuprofen-and-acetaminophen-oral-route/description/drg-20526898
31. Medications That Cause Constipation: List, Solutions, and More – Healthline, accessed on August 9, 2025, https://www.healthline.com/health/constipation/medications-that-cause-constipation
32. NSAIDs (Nonsteroidal Anti-Inflammatory Drugs): Uses – Cleveland Clinic, accessed on August 9, 2025, https://my.clevelandclinic.org/health/treatments/11086-non-steroidal-anti-inflammatory-medicines-nsaids
33. Constipation – Diagnosis and treatment – Mayo Clinic, accessed on August 9, 2025, https://www.mayoclinic.org/diseases-conditions/constipation/diagnosis-treatment/drc-20354259
34. Eating, Diet, & Nutrition for Constipation – NIDDK, accessed on August 9, 2025, https://www.niddk.nih.gov/health-information/digestive-diseases/constipation/eating-diet-nutrition
35. Medicines and constipation | Healthify, accessed on August 9, 2025, https://healthify.nz/medicines-a-z/m/medicines-and-constipation
36. Diets for Constipation – PMC, accessed on August 9, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC4291444/
37. How to Treat Constipation Caused by Your Medications – BC Cancer, accessed on August 9, 2025, http://www.bccancer.bc.ca/health-info/coping-with-cancer/managing-symptoms-side-effects/constipation-caused-by-your-medications
38. Bowel Management When Taking Pain or Other Constipating Medicine – Cooper University Health Care, accessed on August 9, 2025, https://www.cooperhealth.org/sites/default/files/pdfs/Bowel%20Management%20While%20Taking%20Pain%20Medication.pdf
39. How to Find Relief for Opioid-Induced Constipation in 5 Steps, accessed on August 9, 2025, https://stillwaterwellness.com/blog/opioid-induced-constipation/
40. Chronic pain: Medication decisions – Mayo Clinic, accessed on August 9, 2025, https://www.mayoclinic.org/diseases-conditions/back-pain/in-depth/chronic-pain-medication-decisions/art-20360371
41. NSAIDs vs. Acetaminophen: Which Over-the-Counter Medicine Should I Use?, accessed on August 9, 2025, https://www.yalemedicine.org/news/acetaminophen-nsaids-over-the-counter-pain-relievers
42. Over-the-counter pain relievers: MedlinePlus Medical Encyclopedia, accessed on August 9, 2025, https://medlineplus.gov/ency/article/002123.htm
43. Pain-relief medicines | healthdirect, accessed on August 9, 2025, https://www.healthdirect.gov.au/pain-relief-medicines
44. 13 Alternatives To NSAIDS For Pain And Inflammation – GlycanAge, accessed on August 9, 2025, https://glycanage.com/blog/health/non-nsaid-anti-inflammatory-drugs
45. Non-Opioid Treatment for Chronic Pain | Made for This Moment – American Society of Anesthesiologists, accessed on August 9, 2025, https://madeforthismoment.asahq.org/pain-management/non-opioid-treatment/
46. The best non-opioid relief for serious pain – Aetna, accessed on August 9, 2025, https://www.aetna.com/health-guide/non-opioid-painkillers.html