Aspirin vs. Aleve for Chronic Pain

As of Mar. 31, 2024, the U.S. Food and Drug Administration (FDA) had received over 220,000 reports of side effects from people who had taken either aspirin, Aleve (naproxen sodium) or generic versions of Aleve.

Disclaimer: Reports sent to the FDA don’t necessarily mean the drug caused an adverse event. Consult a health care professional before stopping or changing medication.

Gastrointestinal bleeding, anemia, drug interactions and breathlessness were the most frequently reported aspirin side effects to the FDA. Gastrointestinal bleeding accounted for over 16,000 reports alone.

According to the FDA, ineffectiveness, itchiness, nausea, headache and dizziness were the most commonly reported side effects of Aleve.

Chronic pain is pain that typically lasts for longer than three months. Some people experience it continuously, while others have intermittent pain. It is a common condition affecting approximately 25% of Americans.

“Aspirin and naproxen are good for acute pain due to inflammation as they also have anti-inflammatory effects,” Dr. Su Hlaing Hnin, a board-certified internal medicine physician with Medical Offices of Manhattan, told Drugwatch. “If used for prolonged periods and in large quantities, they can cause adverse drug reactions such as stomach ulcers, kidney injury and prolonged bleeding.”

Causes for chronic pain include physical and mental health conditions, injuries, surgery and medical devices. Because pain can affect all aspects of a person’s life, symptom management is crucial. Effective treatment begins with a correct diagnosis and may include prescription medications, lifestyle modifications, mind-body treatments and behavioral therapy.

Many patients choose to manage chronic pain with over-the-counter (OTC) medications. Aleve and aspirin are two types of OTC pain relievers that may help with symptom management. They are generally considered safe when taken as directed and have minimal side effects. However, each works uniquely, so understanding the differences can help you decide whether to use Aleve or aspirin for chronic pain.

Many people use Aspirin to treat minor aches and pains from chronic conditions, including arthritis, headaches, menstrual periods, muscle pain and toothaches. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) with the active ingredient acetylsalicylic acid. Like other NSAIDs, aspirin works by inhibiting an enzyme called cyclooxygenase (COX) that contributes to inflammation, swelling, pain and fever. It is generally fast-acting, with some formulas working in about 15 minutes.

Aspirin is an “effective pain reliever and fever reducer,” Dr. Taher Saifulla, the founder of the Spine and Pain Institute in Los Angeles, told Drugwatch.

Many people take low-dose aspirin tablets for heart health. Aspirin is a blood thinner that may help reduce the risk of heart attack, blood clot and stroke in patients at high risk of these conditions.

However, there are risks associated with long-term aspirin use. For example, it can damage the stomach lining and cause bleeding. Doctors can advise their patients on the risks and benefits of starting a daily aspirin regimen.

Aleve provides pain relief from conditions such as arthritis, back pain, headache, muscle pain and toothaches. It contains naproxen sodium, an active ingredient that works similarly to aspirin by inhibiting COX-1 and COX-2 enzymes.

“Naproxen is a powerful NSAID that provides longer-lasting pain relief and reduces inflammation — good for chronic pain conditions like arthritis,” Saifullah said.

People can take one tablet of Aleve once every 12 hours. The long-lasting pain relief can make Aleve a good fit for chronic pain. However, it is advisable to consult a health care provider to discuss the benefits and risks of long-term use.

Common side effects of Aspirin and aleve include stomach upset, nausea and other digestive symptoms. Both aspirin and Aleve inhibit the enzyme cyclooxygenase, of which there are two kinds: COX-1 and COX-2. Aspirin inhibits COX-1 more than COX-2, while aleve inhibits both without preference.

COX-1 narrows arteries, helps platelets bind and protects the stomach lining. COX-2 widens arteries and causes swelling and pain. By inhibiting both these enzymes, aspirin and Aleve may reduce pain and swelling but also cause gastrointestinal problems.

Some people may experience a rash when taking aspirin for chronic pain or similar conditions. There is also a connection between NSAID use and serious medical conditions, including congestive heart failure, Stevens-Johnson syndrome, anaphylaxis and heart attack from increased water retention.

“[Aspirin] ups your risk for stomach ulcers and bleeding, especially with long-term use — it’s not recommended for children or people with certain medical conditions,” Saifulla said. “Similar to aspirin, [naproxen] can irritate the stomach and increase the risk of ulcers — it may not be suitable for everyone due to potential kidney problems with long-term use.”

Anyone with a history of allergic reactions to aspirin should not take aspirin or Aleve for chronic pain. Patients taking either medication who develop signs of an allergic reaction, such as rash, trouble breathing or swelling around the face or throat, should seek immediate medical attention.

Patients with certain medical conditions, including anemia, hemophilia, hemorrhoids, ulcers, ulcerative colitis and other gastrointestinal disorders, should avoid NSAIDs or limit their use. Additionally, doctors generally advise against taking NSAIDs, including aspirin and Aleve, during the second half of pregnancy because of potential fetal development complications.

Because both medications work similarly, they share many common side effects. However, certain differences may make one a better choice for some patients.

When comparing aspirin and Aleve, consider the potential side effects, patient circumstances and potential interactions with other medications.

People commonly use Aleve for chronic pain relief because it lasts longer than many common NSAIDs. However, there are extended-release versions of aspirin medications as well. Individual health concerns and medical history can influence which drug is best suited for chronic pain relief.

Both medications are available without a prescription, provide reliable pain relief for minor aches and pains, and may effectively address some chronic pain.

“If you’re experiencing chronic pain, consult a doctor to develop a personalized treatment plan,” Saifullah said. “OTC meds might play a role, but they shouldn’t be the only solution.”

Editor Lindsay Donaldson contributed to this article.