Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
What Are NSAIDs?
NSAIDs are a class of drugs that all function in similar ways. NSAIDs can relieve pain, decrease inflammation, reduce fever, and act as a blood thinner. The group includes the common over the counter drugs Ibuprofen (also called Advil and Motrin), Naproxen (Aleve), and aspirin (Excedrin, Bayer, etc). There are also numerous prescription strength NSAIDs including Indomethacin (Indocin), Ketorolac (Toradol), Oxaprozin (Daypro), diclofenac (Voltaren) and diflusinal (Dolobid). Additionally, there is a new subclass of these drugs called COX-2 inhibitors. This subclass, which contains the drug celecoxib (Celebrex), shares many of the characteristics of general NSAIDs, although they also have some unique characteristics and problems. COX-2 inhibitors do not act as blood thinners and do not reduce fever, but they do reduce pain and decrease inflammation. They also cause less problems in the GI track but can cause cardiac problems. The newest subclass is a COX-3 drugs called Limbrel. This also relieves pain but does not thin blood.
Why Taking NSAIDs Can Be Bad
NSAIDs block pain
When you take an NSAID, you feel better because the drug blocks the feelings of pain that your body is producing. However, NSAIDs do not get rid of the pain, they only keep you from feeling it for awhile. Pain is you body's way of telling you that something is wrong and damage is being done to some part of your body. When you don't feel the pain, you may use the injured area more and actually hurt it worse because you are not feeling the pain. When the medication wears off, the pain is worse than before. Or, if you keep taking the pain pills, eventually the pain gets so bad that you can feel it even while you are still taking the drugs. If treated promptly, many pains can be resolved and the damage reversed. If you wait until the pain (and therefore the damage) is much worse, it may be much more difficult to eliminate the pain.
NSAIDs can cause gastrointestinal problems
NSAIDs can cause a variety of stomach and intestinal problems. The most common are fairly mild, like heartburn, which can be uncomfortable, but not very serious. But in some patients, more serious conditions like bleeding into the GI system can occur. Although this condition is uncommon, it can lead to serious complications and death. In fact, it was estimated in a New England Journal of Medicine article that 16,500 deaths occur in the US every year that are related to NSAID use.
NSAIDs can slow healing
Multiple studies have shown that using NSAIDs can slow the healing of broken bones, damaged ligament and other tissues. If you are trying to heal the damage done to a knee, shoulder or other joint, using NSAIDs can significantly lengthen the healing time.
One of the major claims of NSAIDs is that they are anti-inflammatory. In some people, like those with rheumatoid arthritis, blocking the inflammatory process is an important part of treating the disease. However, in healthy people, the inflammatory response is part of the body's normal process in healing injuries. Similarly, swelling around an injury is part of the body's normal reaction to an injury. There has been no evidence to suggest that blocking or decreasing swelling and inflammation have any effect on speeding healing. In fact, by blocking these processes, NSAIDs can actually delay the healing process.
One recent study looked at the effect of Toradol (ketorolac) on the results of ACL reconstruction surgery. They found that one injection of Toradol given before the surgery to help control post-op pain resulted in significantly greater laxity in the repaired knee six weeks after the surgery.
What To Use Instead of NSAIDs
Rest
If something causes pain, it is a sign that you are doing damage to that joint. Stopping the activity and giving the joint time to heal often is enough to resolve the problem. If you are not causing pain and not taking pain pills, then it is unlikely that you are causing further damage. If the problem is in your leg, using a crutch, cane, wheelchair or brace can help remove your body weight from the joint and give it an opportunity to heal. If the problem is in your shoulder, modifying your activity so that you keep your elbows near your body instead of reaching away from your body can help. Dr Prodromos can make other suggestions for modifying your activities that will allow your body time to heal.
Ice
Ice is excellent in relieving pain. It is cheap and easy to use and does not have any side effects. It should be used continuously for best relief. Make sure the ice is not directly on the skin or is not so cold that it is uncomfortable. It is possible to "burn" the skin if direct contact is made or the area is kept uncomfortably cold.
Tylenol (Acetaminophen)
Tylenol is not an NSAID but it is a good pain killer. It does not have the same effects on healing tissue, although it has its own toxcity problems. In some cases, it can cause liver damage, especially if too much is taken. If an over the counter pain killer must be taken, it usually is a better choice than an NSAID. However, since it will block pain, it can lead to the same cycle of increasing damage requiring increasing pain medication that NSAIDs do.
No Pain, No Pills
Ultimately, the goal of any treatment is to get you feeling better. At first glance, pills seem to be the quick and easy way to reach this goal. But taking NSAIDs slow healing and actually encourage you to damage yourself more, because you cannot feel the pain that indicates that you are hurting yourself. Slowing down, taking the pressure off (with a crutch, rest, etc) and giving your joint the time it needs will minimize ongoing tissue damage and allow healing and recovery to occur at the fastest possible rate.