Ibuprofen is the most popular NSAID (non-steroidal anti-inflammatory drug) in North America. It is commonly prescribed in the treatment of musculoskeletal injuries and it is estimated that more than 30 million people take NSAIDs daily for a variety of conditions ranging from headaches to low back pain.
There are so many NSAIDs that many of us get confused. The term NSAID is a class of drugs. The term ibuprofen is the actual drug. The names Advil and Motrin are the band names that you would see in the local pharmacy. Other popular NSAIDs are aspirin (Bayer, Excedrin), celecoxib (Celebrex), diclofenac sodium (Voltaren), meloxicam (Mobic), nabumetone (Relafen), naproxen (Naprosyn) and naproxen sodium (Aleve). Note that acetaminophen (Tylenol) is not on the list. Tylenol belongs to a class of drugs called analgesics or pain relievers and antipyretics or fever reducers. Tylenol has little effect on underlying inflammation, redness and swelling of the joint.
As the class name suggests, non-steroidal anti-inflammatory drugs (NSAIDs) reduce inflammation but are not related to steroids which also reduce inflammation. NSAIDs work by reducing the production of prostaglandins in the body. Prostaglandins are chemicals that promote inflammation, pain, and fever.
Are NSAIDs safe to use?
Unfortunately, NSAIDs like Ibuprofen are associated with potential adverse gastrointestinal, kidney, liver and cardiovascular effects. In fact, the use of prescription NSAIDs is reported to be the 15th most common cause of death in the United States due to GI complications. Besides being a more potent risk to our overall health than most of us know, NSAIDs might also be a poor choice for the common injuries that most of us believe them to be effective for, but more on that later!
What is the evidence supporting NSAID use?
There are research studies that demonstrate that NSAID use can decrease pain in conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, gout and tension headaches. Note that these conditions are not a natural inflammatory response to acute soft tissue trauma following a specific trauma; they are a condition involving an abnormal inflammatory response. Furthermore, there are multiple studies supporting the use of NSAIDs on soft tissue injuries such as neck and low back pain. Unfortunately, most of these studies demonstrate only short term symptomatic relief and do not factor in the long-term effects and recurrence rates with and without NSAIDs.
Could the use of NSAIDs after acute musculoskeletal injuries actually increase the risk of recurrence due to inadequate tissue repair?
Admittedly, more research needs to be conducted on this topic, but there is some interesting evidence that supports the notion that NSAID use reduces the quality and strength of bones and soft tissues during healing. In studies by Warden et al 2006, Ferry et al 2007, Dimmens et al 2009, Chechik et al 2014, Cohen et al 2006 Chen et al 2013, O’Connor et al 2009 and Dahners et al 2004, animals with artificially induced musculoskeletal injuries demonstrated significantly delayed healing with the use of NSAIDs compared to a control group. Here are a few quotes from these research studies:
“Anti-inflammatory drugs…had a detrimental effect on healing strength at the bone-tendon junction…” (Ferry et al 2007)
“…NSAIDs significantly inhibited tendon-to-bone healing…If the results of this study are verified in a larger animal model, the common practice of administering NSAIDs after rotator cuff repair should be reconsidered.” (Cohen et al 2006)
“When fracture healing or spine fusion is desired, NSAIDs should be avoided.” (Dahners et al 2004)
“By suppressing the initial inflammatory reaction, the NSAID permits improved performance in early time-periods but appears to suppress the stimulus that may be needed for cellular remodeling in longer time-periods.” (Mishra et al 1995)
Unfortunately, most of the above research has been conducted on laboratory animals as humans do not typically consent to experimentally induced injuries followed by histological examination!
Are NSAIDs a bad choice for your injury?
Considering the cardiovascular and gastrointestinal risks and the potential hindrance to tissue recovery, it seems prudent to use caution when recommending NSAIDs to patients after musculoskeletal injuries and to recommend their use to be of short duration, if at all.
What could be a replacement for NSAIDs?
There is a growing body of research that demonstrates that exercise has an anti-inflammatory effect. Therefore, instead of immediately reaching for the ibuprofen, perhaps the correct amount of exercise, in the right direction performed at the optimal intensity and frequency may be more effective in both the short and long-term, in individuals after acute musculoskeletal injuries. If you would like professional guidance in selecting the right exercises for your condition, please contact us at Back to Function. One of our highly skilled doctors can evaluate your condition, render a diagnosis and guide you safely and effectively on the road to feel, recover and perform better. Please call 310-534-1900 or email firstname.lastname@example.org to schedule your assessment today!