In the last blog, we left off talking about the repercussions associated with NSAID use. The main important point to differentiate is the primary groups of anti-inflammatory medication used. The first are NSAIDs and the second are COX-2 inhibitors. COX-2 inhibitors were created because long-term use of NSAIDs is associated with gastrointestinal, renal, and cardiovascular side effects. COX-2 inhibitors were highly touted as they did not have these side effects. However, it was later found that COX-2 inhibitors had potentially serious consequences with the cardiovascular system, so practitioners began decreasing the frequency  they prescribed the medication. These are the serious side affects of NSAIDs on organ function, but NSAIDs are designed to affect body tissue, which can also have side effects.

NSAIDs affect the different tissues in the body uniquely, so it is important to understand and differentiate what kind of tissue is injured in order to know if NSAIDs will be effective for it. We will go through the main tissue types that NSAIDs are commonly used for. The studies available for review are a mix of human and animal trials. Let’s delve deeper into each tissue.

Muscle: NSAID’s use with muscle soreness has been shown to help with short-term muscle pain, but it does not have any effect on long-term pain and muscle healing [1]. Many people talk about using NSAIDs to help their upper shoulders feel less painful after a long day at work. The shoulders feel better for awhile, but then they go back to where they were before. This is because NSAIDs are a short-term way to mask the pain, but they are not helping the underlying problem(s).

Bone: If there is a fracture, it is wise to avoid long term NSIAD use. Patients who used NSAIDs during the first 3 months after a fracture had a 4-fold risk of their fracture not healing properly [1]. Further animal and human studies found that even taking NSIADs for only 1 to 2 weeks can delay fracture healing [1]. In a study of 42 patients with Colles’ fractures (a type of wrist fracture), 6 out of the 21 patients who took NSAIDs had a non-union. Out of the 21 patients who did not take NSAIDs, all had their fractures unionize [2]. Out of all of the tissues tested with NSAID use, bone has the most conclusive research that NSAIDs have a negative effect on its healing.

Ligament: No significant differences have been seen with ligament healing in animal studies over long term follow ups [2]. However, when NSAIDs were provided to subjects with grade 1 or 2 ankle sprains there was less pain and earlier functional recovery [1].

Tendon: Tendon attaches a muscle to a bone. This is important to know because sometimes an injury happens on the tendon body itself, and sometimes it happens where the tendon actually inserts on the bone. One aspect that was postulated by physicians was that NSAIDs actually improved tendon regeneration during an injury. The thought behind this was that neutrophils and macrophages (the ‘Pac-Man’ particles that clean up an area) can exacerbate a tissue injury, and using NSAIDs to reduce the number of these cells in the area would lead to less degradation of the tendon. Marsolais et al. found in 2003 that this was actually not the case. Though neutrophils and macrophages were fewer after taking NSAIDs, there was no improvement in tendon regeneration. If an injury is on a tendon, most evidence states that NSAIDs have little effect on the tendon healing other than decreasing pain [1]. However, if the injury is at the insertion of a tendon and bone, (many rotator cuff tears are here) NSAIDs have been shown to delay healing time [2]. Studies show that the failure load after healing on the tendon is actually much lower when NSAIDs are used for two weeks after a rotator cuff repair in a rat model [2].

Bayer first introduced aspirin in 1897 and since then NSAIDs have become a mainstay in any American household. Though NSAIDs have the potential to decrease inflammation and pain, they also have effects that can be detrimental to our stomach, kidneys, and heart. Additionally, NSAIDs can have negative effects on the tissue on our body. Knowledge is power and I hope that information in this blog will help you, the consumer, make an educated decision on when to use NSAIDs and when to let the body heal itself naturally. If you have questions or concerns regarding the use of NSAIDs or other medications, contact your medical provider to discuss the appropriate plan of action.

 Works Cited
[1] Patel, D., & Adrian, B. (2011). Do nsaids impair healing of musculoskeletal injuries? – see more at: http://www.rheumatologynetwork.com/articles/do-nsaids-impair-healing-musculoskeletal-injuries
[2] O’Conner, J., & Lysz, T. (2008). Celevoxib, nsaids, and the skeleton. Drugs Today, 44(9), 693-709.
[3] Marsolias, D., & Frenette, J. (2005). [inflammation and tendon healing]. Med Sci, 21(2), 161-168.