Painkillers are something many people take without giving much thought to their stomach. They may be used for headaches, muscle aches, joint pain, menstrual cramps, sports injuries, or chronic pain, and when they are readily available, it can be easy to assume that regular use carries little risk.
However, some commonly used painkillers, particularly non-steroidal anti-inflammatory drugs (NSAIDs), can affect the protective lining of the stomach and increase the risk of gastritis and peptic ulcers. The risk can be greater when these medicines are taken frequently, for prolonged periods, or in people who have additional risk factors.
So, if you’ve started experiencing persistent upper abdominal pain and regularly take painkillers, it is worth considering whether your medication could be contributing to your symptoms.
Key Takeaways
- NSAIDs are a group of painkillers that can irritate and weaken the stomach’s protective lining.
- Frequent or prolonged NSAID use can increase the risk of gastritis and peptic ulcers.
- An ulcer may cause upper abdominal pain, but some people have few or no obvious symptoms.
- Black stools, vomiting blood, persistent abdominal pain, or unexplained weight loss should prompt medical attention.
- Gastroscopy and Helicobacter pylori (H. pylori) testing may be considered when investigating suspected peptic ulcers.
Which painkillers can irritate the stomach?
Not every type of painkiller affects the digestive system in the same way. The medications most commonly associated with stomach irritation and peptic ulcers belong to a group known as NSAIDs, or non-steroidal anti-inflammatory drugs. These medicines reduce pain and inflammation and are commonly used for a wide range of everyday conditions.
Examples of NSAIDs include:
- Ibuprofen
- Naproxen
- Diclofenac
- Aspirin
Some NSAIDs are available without a prescription, while others may be prescribed. Because they are so commonly used, people may not immediately associate them with new digestive symptoms.
Why can NSAIDs cause gastritis or stomach ulcers?
The stomach has a natural protective barrier that helps shield its lining from digestive acid. NSAIDs interfere with the production of substances called prostaglandins, which play an important role in maintaining this protective lining.
When that protection is reduced, the stomach and duodenum may become more vulnerable to irritation and injury. This can contribute to gastritis, which is inflammation of the stomach lining, or to the development of a peptic ulcer, an open sore in the lining of the stomach or duodenum.
The risk may be greater with frequent or prolonged NSAID use and can also depend on factors such as age, dose, other medications, previous ulcers, and H. pylori infection.
I take painkillers regularly, could they be causing my stomach pain?
They could be one possible explanation, particularly if you regularly take NSAIDs and have developed new or persistent upper abdominal discomfort. However, stomach pain has many possible causes, so symptoms alone cannot confirm that an NSAID-related ulcer is responsible.
Pain associated with gastritis or a peptic ulcer may feel like:
- Burning or aching in the upper abdomen
- Discomfort around the upper middle part of the stomach
- Pain that changes in relation to eating
- Bloating or uncomfortable fullness
- Nausea
If pain repeatedly returns, particularly while you are taking NSAIDs, it is worth discussing both your symptoms and medication use with a doctor.
Where is stomach ulcer pain usually felt?
People often expect an ulcer to cause severe or very specific pain, but the experience can vary considerably. Peptic ulcer pain is commonly felt in the upper abdomen, particularly between the breastbone and the belly button, although the exact location and sensation may differ between individuals.
Some people describe the discomfort as burning, gnawing, or aching. Symptoms may occur when the stomach is empty, after eating, or at night, depending partly on where the ulcer is located.
Because reflux, gastritis, gallbladder conditions, and other digestive disorders can cause similar discomfort, the location of pain alone is not enough to diagnose an ulcer.
Can you have a stomach ulcer without obvious symptoms?
Yes. One reason medication-related ulcers can be difficult to recognise is that not everyone develops noticeable pain or indigestion. In some people, an ulcer may remain relatively silent until a complication such as bleeding occurs.
This means the absence of significant stomach pain does not necessarily rule out an ulcer, particularly in someone with risk factors such as prolonged NSAID use.
For this reason, changes such as unexplained anaemia, dark stools, or other signs of gastrointestinal bleeding should not be dismissed simply because there is little or no abdominal pain.
What are the warning signs of a bleeding or complicated ulcer?
Most episodes of indigestion or stomach discomfort are not emergencies, but certain symptoms require more urgent assessment. An ulcer can sometimes bleed or, less commonly, lead to other complications, and the first sign may be different from the typical burning stomach pain people associate with ulcers.
Seek prompt medical attention if you experience:
- Black, tarry stools
- Vomiting blood or material that resembles coffee grounds
- Sudden or severe abdominal pain
- Persistent vomiting
- Dizziness, faintness, or unusual weakness
- Unexplained weight loss
- Persistent or worsening abdominal pain
Vomiting blood, passing black stools, or developing sudden severe abdominal pain may require urgent medical care.
Does H. pylori also cause stomach ulcers?
NSAIDs are not the only common cause of peptic ulcers. Another important factor is infection with Helicobacter pylori (H. pylori), a bacterium that can live in the stomach lining and contribute to inflammation and ulcer formation.
A person may have H. pylori without knowing it because the infection does not always cause noticeable symptoms. When investigating a suspected ulcer, a doctor may therefore consider both medication use and the possibility of H. pylori infection.
Testing can be performed in different ways depending on the clinical situation, including breath, stool, or biopsy-based testing.
Should I stop taking my painkillers if my stomach hurts?
If you suspect your medication is affecting your stomach, it can be tempting to simply stop taking it. However, the appropriate next step depends on why the medication was prescribed, how frequently you take it, and your overall medical history.
Rather than changing a prescribed medication without advice, speak with the doctor who prescribed it or another healthcare professional. They can review:
- Which painkiller you are taking
- The dose and frequency
- How long you have been using it
- Your digestive symptoms
- Other medicines you take
- Any previous history of gastritis or ulcers
Depending on your circumstances, changes to medication or additional stomach protection may be considered.
How does a gastroenterologist investigate persistent stomach pain?
When stomach pain continues or an ulcer is suspected, evaluation usually begins with a detailed discussion about the symptoms rather than immediately proceeding to a procedure. Medication history is particularly important because people may not think to mention occasional or over-the-counter painkiller use unless specifically asked.
A gastroenterologist may ask about:
- Where the pain is located
- Whether it occurs before or after meals
- How long symptoms have been present
- NSAID and aspirin use
- Previous ulcers
- Symptoms of gastrointestinal bleeding
- Unexplained weight loss
- Other medications and medical conditions
Depending on these findings, further testing may be recommended.
When might gastroscopy be recommended for suspected stomach ulcers?
A gastroscopy allows a doctor to examine the lining of the oesophagus, stomach, and duodenum directly. It can help identify inflammation, ulcers, bleeding, and other abnormalities that may not be apparent from symptoms alone.
Gastroscopy may be considered when symptoms are persistent, when there are warning signs, or when the clinical history suggests that direct examination of the upper digestive tract would be useful.
During the procedure, small tissue samples may also be collected when appropriate, including samples that can help assess for H. pylori.
FAQs About Painkillers and Stomach Ulcers
1. How long do you have to take NSAIDs before they can cause an ulcer?
There is no single amount of time that applies to everyone. Risk depends on factors such as the type and dose of NSAID, frequency of use, age, previous ulcer history, other medications, and H. pylori infection.
2. Can occasional ibuprofen cause stomach problems?
Occasional NSAID use may still cause digestive irritation in some people, although the risk of ulcers generally increases with higher doses and more frequent or prolonged use. Individual risk factors also matter.
3. What does an NSAID-related stomach ulcer feel like?
It may cause burning, aching, or gnawing discomfort in the upper abdomen, sometimes associated with nausea or bloating. However, some ulcers cause few or no obvious symptoms.
4. Can a stomach ulcer heal if I stop taking NSAIDs?
Many peptic ulcers can heal with appropriate management, but treatment depends on the cause and severity of the ulcer. Medication changes should be discussed with a doctor, particularly if the NSAID has been prescribed for another medical condition.
5. When should I see a gastroenterologist for stomach pain while taking painkillers?
Consider medical assessment if stomach pain persists or repeatedly returns, particularly if you regularly use NSAIDs. Symptoms such as black stools, vomiting blood, unexplained weight loss, anaemia, or persistent vomiting should be assessed promptly.
Taking Painkillers Regularly and Experiencing Stomach Pain? Check With a Doctor Why
Pain relief may be part of your regular routine, but persistent stomach discomfort should not simply become part of it too.
If you frequently take NSAIDs and have developed recurring upper abdominal pain, indigestion, nausea, or other digestive symptoms, a medical assessment can help determine whether gastritis, a peptic ulcer, H. pylori, or another digestive condition may be contributing.
At GastroClinic, Dr Lin Cui Li assesses stomach and digestive symptoms and can advise whether investigations such as H. pylori testing or gastroscopy may be appropriate based on your symptoms and medical history.
Concerned about persistent stomach pain while taking painkillers? Book a consultation with GastroClinic to discuss your symptoms and the appropriate next steps.
