Non steroidal anti-inflammatory drugs: Some facts to think about.

Carol PlumridgeUseful information

NSAID

(non steroidal anti inflammatory drugs)

Tablets

Lots of tablets

Some facts for sportsmen and women.

Here are some facts and figures about taking NSAID’s that you may want to consider. As with any drug treatment speak to a professional first, either a pharmacist, GP or practice nurse.

2002: NZ marathon 13% participants took NSAID’s before the race.

2002-3: 86% Italian footballers take NSAID’s

2002/6: Football World Cup: 50% players took during tournament and 10% before every game.

2010: 39% every player before game, some team players taking 3 painkillers before every game.

2008: Ironman trials Brazil: 60% take NSAID’s

Young players copy senior players older football players, 19% take NSAID’s.

Why do athletes take them?

  • Athletes perception:
  • Pain prevention.
  • Soreness prevention during and post event.
  • Lack of confidence in self recovery
  • Psychological addition
  • Seen as harmless
  • Peer pressure
  • Self-medication encouraged.

Why not?

Dr. Stuart Warden et al British journal of Sports medicine 2009 “ Prophylactic use of NSAID’s not safe”. i.e. taking them “just in case”.

No indication or rationale for prophylactic NSAID’s taking in sport; therefore constitutes misuse.

Should only be used when pain and inflammation are present.

Early use of NSAID in soft tissue injury (STI).

  • The benefits are minimal over alternatives and risks not fully known.
  • They may impair tissue regeneration if administered in early stages.
  • The mild effects on symptom relief are counterbalanced by deleterious effects on tissue repair.
  • Tendinopathy: Reduced tendon healing with NSAID’s and apart from Ibuprofen NSAID’s can reduce tendon strength. No evidence of benefit for NSAID’s in tendon treatment.
  • Negative effects on bone and ligament healing and repair, mostly demonstrated in prolonged usage.
  • Evidence of delayed degradation of scar tissue. Not recommended in treatment of completed fractures, stress fractures are less liable to unify.
  • Paracetamol similar efficiency to NSAID’s in STI, is cheaper and has lower side effect profile (provided recommended dosage is strictly adhered to). Paracetamol is analgesic of choice for most STI.
  • Therefore the use of NSAID’S to treat muscle, ligament and tendon injuries should be reassessed.

 When to take NSAID’s:

  • STI’s associated with definite inflammatory conditions such as bursitis or synovitis or involving nerve impingement does warrant short term treatment with NSAID’s.

Side effects and contraindications:

  • Adversely interacts with many common medications due to effects on the kidneys.
  • Analgesic (pain relief) usage is limited.
  • I risks. Nausea, vomiting, diarrhoea, abdominal pain.
  • Risk groups for cardio vascular, renal (kidney) and hepatic (liver) involvement. Increased risk of heart attacks with pre existing heart disease.
  • Bronchospasm with asthmatics, decreased fertility in women.
  • Drug interactions: Numerous.
  • Prescribing: NSAID’s contribute to 2000 deaths p/a.
  • Take the minimum dose for shortest time. Highly variable response, try another if first not effective.
  • OA knee consider topical application.
  • 20% patients taking over the counter NSAID’s see the GP re side effects.

Always consult a health professional before taking any medication.