Simplifying rehab complications.

Nearly every runner reaches for non-steroidal anti-inflammatory medications (NSAIDs) like aspirin and ibuprofen from time to time for relief of running-related pain. And nearly every runner knows that those drugs come with significant risks of complications-primarily gastrointestinal bleeding or perforation. In a recent review of the studies of serious gastrointestinal tract complications due to non-aspirin NSAIDs, the risk of complication was tested against independent risk factors for gastrointestinal complications. The news can be of some reassurance to runners who need a little NSAID help now and then.

Risk of complication increases with the dose--in other words, the higher the dose of NSAID, the higher the risk of a gastrointestinal event. Risk also increases the longer the time spent on the medication. More important for many runners is that increased age and a history of an ulcer increases the risk dramatically. What this means for the average runner without a history of an ulcer, is that you should be able to depend on occasional use of NSAIDs to relieve sports-related pain with caution, but less worry. Just like one really good exam grade can ruin the curve for the rest of the class, higher than average risks for one group can tend to overstate the risks for the average individual and especially for those at lowest relative risk--young, healthy individuals.

Of course, it isn't reassuring news at all for older runners and those who have had stomach ulcers. Those runners need to be even more vigilant about NSAID use. You can talk to your doctor about COX-2 NSAIDs like Celebrex and Vioxx, which are reported to have lower risk for gastrointestinal bleeding than earlier NSAIDs. Everyone who experiences occasional sports-related pain should try RICE first (rest, ice, compression, elevation).

(Archives of Internal Medicine, 2000, Vol. 160, No. 14, pp. 2093-2099)