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Articles > The Use of Anti-Inflammatory Drugs

by Peter Holleran, DC

   The use of NSAID’s (non-steroidal anti inflammatory drugs) for ordinary aches and pains, arthritis, soft tissue injuries, and during endurance events, has become commonplace. From Advil to cortisone injections, the pharmaceutical model of cure has us convinced that pain and inflammation are bad and should be stopped as early as possible. This is not just a matter of medical philosophy, it is also big business.

   I will admit up front that, as a runner, I use aspirin and Advil occasionally when I need to decrease pain in order to compete in or finish a major event. Is this a good thing, however, or just a way of getting by until I can spare the time to let nature do its healing work? I believe the answer is the latter, for a number of sound reasons. Therefore, for me, that event better be something really big - like running across the Grand Canyon or climbing Pikes Peak! - but even then I will think twice, for other reasons given below.

   The purpose of NSAID’s is to inhibit the prostaglandins that are pro-inflammatory mediators producing painful stimuli in the body. They definitely achieve this effect, reducing pain and swelling, and letting a person engage in motion earlier in the recovery process than he ordinarily would. This may, in fact, be useful if he doesn't re-injure himself in the process. There is, however, a price to pay for this “grace period”. For inflammation, while painful, is also nature’s way of beginning the process of healing soft tissue. The inflammatory reponse helps remove cellular debris from areas of injury allowing quicker healing. It makes no more sense to take aspirin to stop inflammation than it does to take it every time one has a fever. A fever is the body’s way of fighting infection, just as inflammation is the first line of defense against acute injury.

   Drugs such as aspirin, Advil (Ibuprofin, Motrin), and Tylenol (which is not an anti-inflammatory, but only reduces pain and fever) are among the chief causes of emergency hospital admissions for acute gastric bleeding, liver and kidney problems. There are also a select few for whom even a single dose can cause a rare and often fatal reacton called SJS (Stevens Johnson Syndrome) or even worse, TENS (Toxic Epidermal Necrolysis), where the person basically burns up from the inside and the skin starts to die. This can happen even though a person has used NSAIDs without problems for years. Without warning their body becomes hypersensitive to the drug and develops an extreme inflammatory immune reaction. Participants in ultra-marathon type events held in hot weather also need to use special caution. Some runners have experienced severe kidney failure from as little as one ibuprofin tablet, although that is not common. These drugs when taken during a race can also interfere with the excretion of water by the body leading to water intoxication and hyponatremia (low sodium), which can cause brain swelling and death. Low sodium levels should be suspected in any runner who becomes breathless and nauseated or collapses after drinking lots of water during a race. This condition may be misdiagnosed and confused with dehydration, with potentially fatal results. The delterious effects of this condition can be greatly enhanced by the consumption of aspartame containing sports drinks or diet sodas which can lead to fatal arhythmias. The use of NSAIDs, therefore, should be judiciously monitored and cautiously considered, expecially in endurance events.

   Simply put, you don’t have a headache or muscle ache because of a deficiency of aspirin, etc., in the blood! The important thing is to find the real cause and to understand what the body is trying to do about it, and then use natural means to support it in that process. Chiropractic is one means that is often great for removing interference to the body’s innate wisdom-response to injury - but there is still a necessary healing process to go through, which should be respected.

   Studies have shown that use of NSAID’s prevents collagen synthesis by the body, thereby potentially degenerating joint cartilage over time. Many arthritis patients who take large doses of these drugs on a daily basis may be asking for worse problems down the road. Fortunately there are many natural arthritis formulas available, containing glucosamine, MSM, cetyl meristoleate, ginger, sea cucumber, etc., that have an actual nutritive benefit for the tissues. They may work slower but are much safer in the long term.

   A study by Elder, et. al., published in the American Journal of Sports Medicine in 2001, concluded that rats who were given knee injections of the Cox-2 inhibitor Celecoxib (similar to Celebrex - which is sometimes given orally in place of drugs such as Advil to minimize gastric symptoms) had a 32% lower load to failure than controls. What this means is that while they may have had less pain, their ligaments were WEAKER after the injections than before. For an athlete, this could mean a quicker return to the playing field, but also a greater chance of re-injury, a scenario that one sees again and again. Healing can be delayed or postponed, but not avoided.

   For these reasons I do not make a regular practise of using Advil or aspirin after ordinary workouts. For a major goal event or race I might take one or two - but only to buy myself time, realizing they are probably delaying true healing, which I must then account for later. If I find myself frequently getting sore after a run or a ride, I will investigate and adjust my routine instead of masking the warning symptoms the body is giving me. Maybe I need to stay more in the stress-decreasing aerobic zone, or back off the distance or length of my workouts. Maybe dietary modifications are warranted (less refined carbohydrates and sugars, more omega-3 oils, more water, etc.). I most likely need a chiropractic adjustment, and some good muscle work, and maybe more sleep. Or new shoes. The same reasoning process applies with non-athletic aches and pains. Find the cause, get rebalanced, and the healing will follow. For common sprains and strains the RICE formula is applied: Rest, Ice, Compression (such as an orthopedic brace or belt, if appropriate), and Elevation. Trainers spray thoroughbreds' legs with cold water after a race, and the equivalent is beneficial for human runners. As marathon legend Jack Foster used to say, "if it's good enough for race horses, it's good enough for me." I have also found homeopathic Arnica very effective for acute injuries such as sprained ankle, sometimes seeing massive discoloration disappear overnight.

   Fortunately there are also some powerful herbal remedies available. Combinations of Curcumin, Boswelia, and White Willow may be taken almost without limit and are effective anti-inflammatory agents. Also tart cherry extract.

   These are just a few of the things to consider before popping that next pill.