Having repeated this bit of info over and over again to a lot of my patients, I decided its time to put it in writing….
Lets me just start off by saying, Anti-Inflammatories are over-prescribed! At the first sign of any pain or swelling, a doctor will usually pull out his/her referral pad and write a script for anti-inflammatories without giving it a second thought. DON’T POP THOSE PILLS!
Worldwide, 73 000 000 prescriptions of Nonsteroidal anti-inflammatory drugs (NSAIDs) are written yearly. Although theses drugs are very useful at relieving pain, decreasing inflammation, decreasing elevated body temperature, and decreasing blood clotting they are also associated with frequent and significant side effects.
The two main problems with the prescribing of NSAIDs are (1) the TIMING of use and (2) the RELEVANCE to the tissue/injury being treated.
(1) Taking NSAIDs during the acute stage of an injury (usually 48-72hrs) is usually not recommended as this STOPS the inflammatory process. Inflammation is the first key step to tissue healing, so by STOPPING this phase, you are delaying the tissue healing process. Rather LIMIT this phase using the PRICE principles (see our previous article “Acute Injury Management”). Taking NSAIDs in the later (regenerative) phase of healing has also been shown to impede regeneration and increase fibrosis in tissue.
That said there is a narrow window period (the sub-acute phase) where NSAIDs could be used. This is usually 72hrs-10days post injury, but could vary depending on the injury and person.
(2) Understanding the injury/pathology- Of considerable importance to us in the Sports Medicine field are the side effects related to impaired healing in ligaments and bones. Ligament injuries treated with NSAIDs in the acute phase have been shown to have up to a 32% decrease in tensile strength, and fractures have been shown to be 5 times more likely not to unite following NSAID use!! But your doctor gave you NSAIDs for that ankle sprain right???
Tendinopathies (like Achilles tendinopathy, Tennis Elbow etc.) are not inflammatory conditions, so the prescribing of NSAIDs in these cases are useless and can only have negative side-effects. Acute muscle tears are another instance where one should rather avoid NSAID’s as they have been shown to delay healing. However, chronic inflammatory conditions like Rheumatoid Arthritis and Tenosynovitis (inflammation of the tendon sheath) do benefit from NSAID use.
So what’s the take home message?
NSAIDs are effective, but their application to specific tissues and injuries are complex, so don’t rush off to the pharmacy and buy them without first consulting your Sports Physio or Physician.
If you do have a musculoskeletal injury, first take Paracetomol (as found in Panado), as it is effective in relieving pain but without the side effects on tissue healing.
If you are not sure, avoid NSAIDs for the first 3 days post injury and don’t take them for more than 7 days without consulting a health professional.
BY: Riccardo Vaccaro