Think Twice About NSAIDs
We’ll return to the new report, but let’s begin by talking about NSAIDs in general. As their name suggests, these are medications (which are not steroids) that were designed and are prescribed for their anti-inflammatory effects. They also have anti-pyretic (fever-reducing) and analgesic (pain-reducing) effects, as well.
- Naproxen - Aleve, Anaprox, Midol Extended Relief
- Ibuprofen - Advil, Motrin, Nuprin
- Indomethacin - Indocin, Indocid
- Sulindac - Clinoril
- Ketorolac - Toradol
- Diclofenac - Voltaren
- Piroxicam - Feldene
- Meloxicam - Mobic
- Celecoxib - Celebrex
- Rofecoxib - Vioxx
- Valdecoxib - Bextra
Rofecoxib, one of the COX2-inhibitors developed by Merck, was approved by the U.S. FDA in May, 1999 for use in the treatment of arthritis, acute pain and menstrual pain. This was a wildly popular drug and eventually, as many as 80,000,000 patients worldwide were treated with Rofecoxib. Before approval of the drug by the FDA, studies of the drug suggested that Rofecoxib had a satisfactory safety profile.
In the current issue of the British Medical Journal, Sven Trelle and his colleagues at the Institute of Social and Preventive Medicine at the University of Bern report on a meta-analysis of previous studies of NSAIDs. This statistical undertaking combines the patient populations in 31 previous studies that included a total of 116,429 patients who received naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. The combined observations from the underlying studies amounted to more than 100,000 patient-years. The authors focused primarily on the development of MI, but also examined the effects of these drugs on the rates of stroke, death from cardiovascular disease, and death from any cause.
Athletes use the NSAIDs when they’re injured. I’ve done it myself. We all have. Personally, I would rely on NSAIDs for their analgesic effects primarily, thinking that any anti-inflammatory effect would be a bonus. I’ve used NSAIDs for weeks in a row when I’ve been injured, primarily to allow me to continue to work (at my job). I’ll bet that many athletes rely on the use of NSAIDs to allow them to continue to train in spite of being injured as well. I’ve also seen athletes use NSAIDs prophylactically during competition to prevent any pain during an event.
- Never use NSAIDs prophylactically to prevent pain during training or racing.
- As a first choice, use an alternative to NSAIDs when choosing an analgesic. Consider acetaminophen or a narcotic pain reliever.
- If you choose to use an NSAID, use it for only a short period of time.
- When injured, emphasize alternatives to medications such as rest, icing, compression, elevation, appropriate medical evaluation and appropriately supervised post-injury rehabilitation.
by Bob Albright, D.O.
Bob Albright, D.O., is a Nephrologist and Assistant Professor of Medicine at the Mayo Clinic in Rochester, Minn. You can contact him at firstname.lastname@example.org.