NSAIDs and Injury Recovery
Is ibuprofen your best bet for injury and inflammation recovery?
Do you ever have aches and pains and reach for a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen? In this article, we will discuss this class of commonly used drugs in detail. First we discuss prevention and non-medicinal treatment and then we dive into adverse side effects. What do you do when you have aches and pains? Or, a hangover? For many, the knee-jerk response is all too often to reach for a bottle of ibuprofen or aspirin.
Anyone who does sports is likely to experience occasional pain in the musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. A lot of musculoskeletal pain can be prevented with appropriate preparation, training, stretching, and proper form. We often forget about the importance of core building exercises and end up with reactive issues like back pain. One key to avoiding injuries is consistency of exercise, so stay motivated. Short term goals lead to long term results. Don’t skip the stretching and balance exercises — these will help in the long run. Here are a few more resources on this subject:
- Stretching for Skiing 101
- Après Ski Stretches
- Injury Prevention for Skiers
- Preparing Your Body for Ski Season
- Your Best Training Move for a Better Ski Season
If you do everything right and still suffer significant aches and pains, it’s important to understand the risks and benefits associated with medications, including over-the-counter drugs.
What are NSAIDs?
Nonsteroidal anti-inflammatory drugs (NSAIDs) are a class of pain relieving medications with anti-inflammatory benefits. There are a lot of these on the market (i.e. aspirin, naproxen, ibuprofen, etc.). In my practice, I deal predominately with the severe side effects of this class of drugs. NSAIDs have more potential side effects than any other class of drugs. Gastrointestinal, neurologic, renal, and allergic effects of NSAIDs are responsible for approximately 12 percent of all hospital admissions related to adverse effects from drugs, and these conditions lead to numerous deaths. My intention is not to unduly scare everyone, but popping these pills like M&Ms is not a good idea. Take these drugs judiciously and be very aware of the side effects. Always discuss with your physician all medications you are taking, even over the counter medications and supplements.
There are more natural and benign ways of dealing with pain and inflammation. Turmeric is an amazing spice to add to your repertoire. Ground from the root of a plant (Curcuma longa L.) in the ginger family, turmeric is found wild in the Himalayas and grown across South Asia. Turmeric powder is surprisingly bland, not hot, tangy or peppery. The November 2006, issue of Arthritis & Rheumatism suggests that turmeric almost completely prevented joint swelling in rats with arthritis. In my practice, we often use this spice in treating patients with inflammatory bowel disease with migratory arthritis. Turmeric also has potential beneficial effects on inflammatory bowel disease. Turmeric powder, mixed with essential oils in a gelatin capsule, is now under clinical test for patients with steroid-dependent Crohn’s disease and ulcerative colitis (chronic inflammatory bowel diseases that affects the lining of the digestive tract). Other studies suggest that turmeric may protect against forms of heart disease, cancer and Alzheimer’s (a degenerative brain disease).
Never forget about the most potent agents to help deal with pain after an injury: ice packs, rest, elevation, and (sometimes) compression. Chronic arthritis can benefit from exercise programs and stretching, or a regular yoga practice. Water aerobics can be fantastic for some patients. Omega-3 agents like fish oil and flaxseed oil, in significant doses, can help avoid use of NSAID agents in our patients.
Side Effects of NSAID Drugs
I consider NSAIDs one of the riskiest classes of over-the-counter drugs. Here’s a breakdown of the potential side effects:
1. It’s rare, but these agents have been associated with liver injury. This may present as abnormal liver enzyme tests on your routine blood work.
2. They can cause renal or kidney damage. NSAIDs can induce several different forms of kidney injury including hemodynamically (dynamics of blood flow) mediated acute kidney injury, electrolyte and acid-base disorders, and acute interstitial nephritis. All of these forms of kidney damage can be quite significant.
3. Can these agents affect your heart? When thinking about cardiovascular risk for patients treated with NSAIDs, it is important to consider the duration and frequency of therapy. Unlike the gastrointestinal side effects, which can occur soon after initiation of therapy, the risk of adverse cardiovascular events (such as myocardial infarction, stroke, or cardiovascular death) is extremely small over a short course of therapy, as might be used for patients with an acute but limited musculoskeletal injury. But over the long term there is an increased risk of heart failure, stroke, heart attack (MI), and death. The magnitude of the risk is best illustrated by a 2013 meta-analysis of predominantly individual participant data from randomized trials that compared nonselective NSAIDs with either placebo or another nonselective NSAID. The analysis utilized data from over 300,000 participants in over 600 trials. After follow-up of approximately one year, the meta-analysis found that major cardiovascular events (a composite of nonfatal MI, nonfatal stroke, or vascular death) were significantly increased compared with placebo for high-dose drug called diclofenac, a NSAID.
4. Nonselective NSAIDs can raise your blood pressure.
5. Nonselective NSAIDs have potentially important gastrointestinal adverse effects, which include dyspepsia, peptic ulcer disease, and bleeding. Death can happen from a perforation of the stomach from an ulcer or massive bleed. A week never goes by that we do not see a patient with a massive bleed or perforation, sometimes resulting in death, from these agents. We always assume we can avoid the side effects if we take the NSAID with meals but this is very often not protective. Most side effects are secondary to the effects these agents have on our stomach after absorption into our bloodstream.
6. NSAIDs can flare pre-existing inflammatory bowel disease such as Crohn’s disease and ulcerative colitis.
7. There is a small potential effect on fracture healing. A small increased risk of nonunion in patients with bone fractures has been reported with the use of NSAIDs or cyclooxygenase (COX)-2 selective agents. Nonunion (failure of a broken bone to knit) is a serious complication of a fracture and may occur when the fracture moves too much, has a poor blood supply or gets infected.
In addition to this broad list, there are more potential side effects, so be sure to always discuss regular use of an NSAID with your physician. If chronic use is needed, please have blood work regularly to look for renal and liver damage. Most of the gastrointestinal side effects are silent until a patient develops a significant ulcer, perforation, or bleed. It’s best to think about more natural ways of treatment before picking up a bottle of your favorite NSAID. Many instances of injury and inflammation can be avoided with seasonal preparation, training, stretching and executing proper form in your sport. If you find yourself in need, ditch the Advil and integrate turmeric, ice, rest, and elevation into your recovery plan. Always discuss all this information with your treating health care providers first.
By Alan Safdi, M.D., FACG
Dr. Alan Safdi is past chairman of the Section of Gastroenterology at Deaconess Hospital and served as co-founder and president of the Ohio Gastroenterology and Liver Institute. Dr. Safdi is board certified in internal medicine and gastroenterology, and is a Fellow of the American College of Gastroenterology. He is former chairman of the Crohn’s and Colitis Medical Advisory Board in Cincinnati and still serves as president of Consultants for Clinical Research. He was also co-founder of eMerge Health Solutions, Consultants for Clinical Research, and outpatient GI and anesthesia programs.
The information included in my posts are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in my posts does not create a physician-patient relationship.