First pick: NSAIDs
Ibuprofen and naproxen hold FDA approval for inflammatory pain. Ibuprofen doses run 200 mg to 800 mg every 6 to 8 hours. The over-the-counter max is 1200 mg per day. The prescription max is 3200 mg per day. Naproxen doses run 220 mg to 500 mg twice daily. A generic ibuprofen tablet costs about 3 cents. A 30-day supply costs less than $5 at most US pharmacies.
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NSAIDs block COX-1 and COX-2 enzymes. That action lowers prostaglandins. Prostaglandins drive swelling, fever, and pain at the site. The FDA requires a boxed warning on all NSAIDs. The warning covers heart attack, stroke, and stomach bleeding. Risk rises with dose and duration.
Contraindications include kidney disease, active ulcer, heart failure, and aspirin-sensitive asthma. Use after 30 weeks of pregnancy is not advised. Warfarin or SSRI use raises GI bleeding risk.
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Options when NSAIDs fail or are blocked
Medical cannabis
No cannabis product has FDA approval for inflammation. THC binds CB1 and CB2 receptors. CBD inhibits FAAH and blocks certain enzymes. The National Academies 2017 review found moderate evidence for cannabis in chronic pain. Evidence for inflammation as a standalone target is limited. NCCIH states that evidence for CBD in pain and inflammation is insufficient.
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Doses for naive users: THC 2.5 mg to 10 mg per dose. CBD 10 mg to 100 mg per day. Common ratios are 1:1 and 20:1 CBD to THC. Dispensary flower costs $10 to $20 per gram in US states with programs. A medical card requires a doctor visit, state registration, and annual fees of $50 to $200. Wait times run days to weeks.
Convenience factors: many dispensaries take cash only. No interstate shipping is allowed. Product batches vary. Lab tests exist but lack standardization.
Topical NSAIDs
Diclofenac gel 1% is FDA approved for osteoarthritis. Systemic absorption is lower than with oral NSAIDs. Cost runs $15 to $30 per tube.
CBD topicals
No FDA approval. Evidence for local inflammation is weak. Cost runs $20 to $60 per ounce.
Pick order
- Generic oral NSAID for acute inflammatory pain, unless contraindicated.
- Topical NSAID for localized joint pain.
- Medical cannabis if NSAIDs fail, are blocked, or state law allows.
- CBD products last, given weak evidence and high cost.
Cost per month: ibuprofen about $5. Topical diclofenac about $25. Medical cannabis about $100 to $300. CBD about $40 to $120. Access: pharmacy counter versus state-licensed dispensary. Onset: NSAIDs 30 to 60 minutes. Inhaled cannabis 5 to 10 minutes. Edibles 30 to 90 minutes. Side effects: NSAIDs cause GI bleed and cardiovascular events. Cannabis causes impaired coordination, dry mouth, and dependence in about 9% of users, per CDC data.