Everything you need to know about NSAIDs but didn't know to ask!

There are many things in life that are a pain in the...BUT, if there is one truth about running, training, and competing, it is that sooner or later, some part of your body will hurt. Almost no one is immune, including the more casual or recreational athlete, and as we age, aches and pains are even harder to avoid because recovery time gradually increases each year. Pain is nature's way to warn us of trouble-ignore it and you could have a serious problem and significant down time.

When damaged from any of various causes, the body produces a sophisticated cascade of events, including inflammation. Inflammation is a natural mechanism for healing after trauma--it takes us out of commission temporarily with pain and swelling, giving the body time to heal. Non-steroidal anti-inflammatory drugs (NSAIDs) are used to reduce the discomfort and inflammation from overuse injury or trauma. NSAIDs take away pain, reduce fever, and lessen inflammation, but it is important to understand their use and risks.

The first NSAID was "discovered" in 1899, a mysterious and miraculous substance called acetylsalicylic acid, and given the name aspirin. This introduced a new class of drugs that were almost as effective as steroids (like cortisone), in reducing inflammation, but much safer to use on a regular basis. The sports world welcomed these non-steroids with open arms (sore shoulders, aching knees, and pain in the neck). To reduce pain and inflammation without the mind-dulling "high" narcotics cause, and without risk of addiction--these non-steroids seem almost too good to be true.

The mechanism of action of NSAIDs is to inhibit the formation and activity of prostaglandins. Prostaglandins have general "housekeeping" functions including the mediation of pain signals to the brain upon trauma or injury, and several protective mechanisms in the gastrointestinal tract.

Pain in the "gut" is a signal to be heeded that some serious irritation is going on. In almost everyone, some slight bleeding into the gut occurs after NSAID use. This in itself is usually not dangerous, but can become serious when ulceration and perforation of the gastrointestinal lining develops. If NSAIDs are used either in spite of stomach pain or because the pain is not perceived, then the consequences can be life threatening. It is important to understand that as we age, pain perception from the gut is diminished. Therefore, older athletes are at greater risk for gastrointestinal complications.

Another group at increased risk for serious side effects is the 10% of asthmatics who suffer aspirin-sensitive bronchospasm. Cross-sensitivity with NSAIDs can produce life-threatening respiratory complications. These individuals should never use NSAIDs.

Accounting for more than 99 million prescriptions in the U.S. annually, NSAIDs are now among the most commonly prescribed classes of medication with at least 24 different agents, four of which (aspirin, ibuprofen, ketoprofen, and naproxen) are available over-the-counter. The US Food and Drug Administration is about to approve a new class of NSAIDs, called "super aspirins," which will be prescribed for arthritis pain and may have fewer side effects.

The over-the-counter NSAIDs are not as potent as their prescription counterparts, but they are widely used. There remains a great deal of professional concern regarding the wide, uncounseled availability of non-prescription NSAIDs due to their potential side effects. (Tylenol, or acetaminophen, is not an NSAID, it's a painkiller.

If some precautions are taken when using these drugs on a short-term basis, they can serve the athletic person very well. For acute trauma or injury, NSAIDs should be avoided for the first 24 hours since their use could prolong bleeding. There is some evidence that the use of NSAIDs for muscle injuries slows the return of muscle strength. It is very important that a physician supervise long-term use, as the risk of serious side effects, such as liver and kidney damage, increases.

All these medications should be taken with food to help protect the stomach. Other gut-irritating substances like alcohol, caffeine, cigarette smoking, and cold remedies that contain aspirin, should be discontinued while taking NSAIDs. Most important, do not ignore stomach pain--gastrointestinal bleeding can develop quickly.

Ed Nessel, R.Ph., MS., MPH, is a pharmacist, biochemist, and professional swim coach in Edison, NJ.

RELATED ARTICLE: Used conscientiously, NSAIDs are a valuable tool for athletes. Remember that pain is often a message that your training should be altered in some way. Too many miles, too fast too soon, biomechanical errors, incorrect footwear can all be causing problems--listen to pain's message. NSAIDs should never be used to mask pain in order to continue to work out. Doing this can lead to more serious injury and delayed healing. Treat the pain temporarily with NSAIDs, but correct the problem over the long run. Ice can also be an extremely effective pain treatment without the risks and side effects associated with NSAIDs.