Every day, millions of people reach for ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or aspirin (Bayer®) to relieve headaches, menstrual cramps, soreness and other common aches and pains.

These popular pain relievers are in a class called non-steroidal anti-inflammatory drugs (NSAIDs). They work like steroids in that they reduce pain and inflammation. But they don’t come with as many potential side effects as steroids. That makes them an effective choice for lots of people. (Another smart choice: Download our prescription discount app to start saving today.)

Still, NSAIDs can come with risks. And they aren’t always safe for people with certain allergies or illnesses, such as kidney disease.

So what pain relief alternatives are there for people who can’t take NSAIDs? To find out, we spoke with Brian Gates, PharmD. He’s a professor of pharmacotherapy at Washington State University.

Why would someone want to take an NSAID?

Gates: Over-the-counter (OTC) NSAIDs are effective for minor aches, pains and fever. And they’re meant for short-term use. When taken for less than 10 days, they are safe for most people. There are also prescription-strength NSAIDs, such as celecoxib (Celebrex®), that are helpful for treating more severe pain and swelling.

NSAIDs are different from other pain relievers such as acetaminophen (Tylenol®) because they also block certain chemicals that cause inflammation in the body. That’s why NSAIDs are especially helpful for people with inflammatory conditions, such as osteoarthritis and mild rheumatoid arthritis.

(Read up on the 4 classes of arthritis medications.)

What are some reasons that a person might not be able to safely take an NSAID?

Gates: First off, NSAIDs cause stomach irritation and can even cause or worsen stomach ulcers. So people who have had a stomach ulcer or a bleeding stomach ulcer in the past should definitely avoid NSAIDs.

And if you’ve ever had an allergic reaction to an NSAID, you should seek alternatives.

NSAIDs should also be used under your doctor’s or pharmacist’s guidance if you’re taking medications to prevent clotting (commonly called blood thinners). That’s because NSAIDs change how blood platelets work and can act as mild blood thinners. So taking an NSAID on top of your blood thinner could worsen bleeding.

There are also a few medical conditions that aren’t a great mix for NSAIDs, such as kidney disease. NSAIDs block certain body chemicals that can reduce blood flow to the kidneys. If you have kidney disease or decreased kidney function, this could lead to injury.

If you’ve had a heart attack, stroke or have been told you have heart failure, talk to your doctor or pharmacist before taking ibuprofen or naproxen. The U.S. Food and Drug Administration has found that non-aspirin NSAIDs are associated with a higher risk of heart problems.

If I can’t safely take an NSAID, what are my other options?

Gates: An alternative is acetaminophen (Tylenol). It doesn’t have the same warnings for stomach irritation, blood thinning and heart or kidney harm as NSAIDs.

Still, it’s important to follow the dosage directions. Taking more acetaminophen than is recommended on the label or as directed by a doctor can harm the liver — especially if combined with alcohol.

If you can’t take NSAID tablets due to stomach irritation or other concerns, a doctor may also prescribe a topical NSAID. These gels could be useful for some types of pain, such as knee pain. A common example is diclofenac (Voltaren Arthritis Pain®).

Some OTC topical options that aren’t NSAIDs are Biofreeze® or Icy Hot®.

Are there any natural pain relievers I can take instead?

Gates: One option is capsaicin. It’s an ingredient found in hot peppers that makes them, well, spicy hot. When put into topical gels and applied to the skin, capsaicin is thought to decrease the intensity of pain signals over time.

You can apply capsaicin gels up to 4 times a day. Just be sure to wash your hands after. You don’t want hot pepper chemicals burning your eyes.

For arthritis pain, some people take supplements that contain glucosamine, chondroitin or MSM. They may be helpful, but they’re not for everyone. Glucosamine can cause an allergic reaction if you have a shellfish allergy. And there’s some concern that chondroitin could cause issues for those taking a blood thinner.

As always, it’s best to discuss any natural products or supplements with a doctor before trying them.

You don’t have to live in pain. If you have a medical condition or are on medications that make taking NSAIDs risky, know that you have options. Talk to your doctor about safe and effective ways to curb pain — and help you get back to doing what you love most.

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