Different NSAIDs?

Question

I've taken three different NSAIDs prescribed by my podiatrist. I was prescribed Voltaren (Diclofenac) this time. I was wondering what makes any of these medications different from each other? Are all NSAIDs different in some way? If so, how? My doctor says some work for certain patients, others don't.

Answer 1

All except aspirin temporarily inactivate an enzyme called cyclo-oxygenase (aspirin permanently inactivates it) which is part of your inflammatory response.

In large trials there are none that relieve pain better than any other. But some patients report that some work better than others for them, so it's common for doctors to try out different ones hoping they find the one that works best for you.

The cyclo-oxygenase enzyme comes in 2 "flavors" COX1 and COX2.  COX 1 lives in your intestinal mucosa and inhibiting it can cause ulcers or GI bleeding. This is the rationale for the "COX 2" inhibitors Celebrex and Vioxx which should cause less GI bleeding than other NSAIDs. However, COX 2 must play an important role in cardiovascular health, because Vioxx was associated with increased heart attacks and strokes, and pulled from the market.

In general, most NSAIDs work the same, but any given patient might get better relief from one or another. Some people also like twice a day dosing, others want something short acting and prefer ibuprofen.