NSAIDS - No longer the standard of care for Musculoskeletal Pain and Injury
NSAIDs are prostaglandin inhibitors. Prostaglandin is a chemical released very early in the inflammation phase of healing. If you sprain your ankle and your ankle becomes very painful, swollen, red, warm to the touch, that's because of the early release of prostaglandin which NSAIDs block. If you inhibit prostaglandin in the early healing phase of an injury, you are blocking the size of the healing stage that can be set so complete remodeling can occur in that tissue. The bigger the stage, the more complete the final outcome for that tissue is gong to be. If you put NSAIDs on board you block your body's ability to produce the best outcome. There is a study called the Kapooka Ankle Sprain Study conducted in the late 1970's, which has been referenced in many medical journals. It was a military study where they took recruits who had ankle sprains and put half of them on an NSAID and half on a placebo. They got them back to marching as soon as they could. The study was promoted as proof that NSAIDS work because the recruits on medication were able to get back to marching sooner with less pain and less swelling than the patients on the placebo. However, at the end of the study, long before doctors understood the negative ramifications of anti-inflammatories on healing, the group that received the placebo had fewer long-term problems and in their post study examination their ankles were much more stable. We now know that 30-40% of athletes given anti-inflammatory drugs will develop chronic ankle instability. Consequently that ankle sprain study is now being used as evidence to show that NSAIDs are actually harmful to the healing of a ligament.
I find it interesting that once I explain why we don't want RIT patients to use NSAIDs during treatment, some become zealous about not using them. They come in and say, "I used to take NSAIDs after I sprained my ankle and it took about four days for the pain to get better and now I don't take the NSAIDs and it still takes four days to get better! So that medication really just covered up my symptoms." NSAIDs still have a role. I tell patients who are on chronic NSAIDs -- for instance, an arthritic patient on whom we are doing prolotherapy -- that, if the only thing that prolotherapy can do is get them off their NSAIDs, it's potentially saving their life. 25,000 people a year die from GI bleeds and related complications from chronic NSAID use and that number does not even count all the heart attack problems these drugs can precipitate.