Indomethacin is a non-steroidal anti-inflammatory drug, or NSAID, much like aspirin, ibuprofen, or Celebrex. NSAIDs reduce pain, swelling, and inflammation, and are used to treat arthritis, bursitis, and gout. Indomethacin works by blocking the formation of prostaglandins by COX1 and COX2 inhibition. However, indomethacin has several undesirable side effects. It interferes with the absorption of calcium, vitamin C, iron and folic acid. If taken during pregnancy, it can damage fetal kidneys. Indomethacin is not suitable for patients taking lithium, as it increases the risk of lithium toxicity, and it should never be taken alongside other NSAIDs or anti-coagulants such as coumarin or warfarin. Liver enzymes must be monitored during treatment, as fatal liver damage has occurred from long-term use. Kidneys and bone marrow can also be destroyed by long-term use of indomethacin. Considering these risks, many patients seek alternatives to indomethacin.
Although not nearly as powerful an analgesic as indomethacin, acetaminophen poses few of the risks. Acetaminophen is considered safe for use during pregnancy and it does not increase lithium toxicity. Similarly, it does not interact with blood thinners or non-steroidal anti-inflammatory drugs. Aspirin is also safe for long-term, low dose consumption. It is inexpensive and available without a prescription. However, the pain control of a dose of acetaminophen is much briefer than that of indomethacin, necessitating redosing several times per day.
Capsaicin creams bridge the gap between pharmaceutical and herbal medical treatments. The active ingredient is derived from chili peppers, and it works by depleting presynaptic substance P, a different method of action than most painkillers. For this reason it can be used alongside milder painkillers, increasing their efficacy without harmful multidrug interactions. However, because capsaicin must be applied topically, it can be difficult to get it to hard-to-reach spots, such as the upper back. It is common for capsaicin creams to cause mild irritation for the first few days of use.
Glucosamine sulfate, unlike pharmaceutical drugs, helps slow the degeneration of connective tissue. The only frequently occurring side effect of glucosamine supplementation is mild gastrointestinal upset, which is far less serious than the potentially fatal side effects of many other pain-control strategies. This substance is not immediately effective, taking six to eight weeks of use beginning to reduce pain. It is important to determine which form of glucosamine is in a product; glucosamine sulfate is the only form of glucosamine shown to be more effective than a placebo.
Naproxen sodium, another non-steroidal anti-inflammatory drug, possesses many of the same properties as indomethacin. Although not as potent, it lacks many of indomethacin's more serious side effects. It is available without a doctor's prescription. However, naproxen sodium cannot be taken alongside other NSAIDs, and it cannot be combined with blood-thinning medication.