Are NSAIDs Safe for Cartilage and Health?

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NSAIDsNSAIDs can help decrease inflammation and pain from musculoskeletal injuries, menstrual cramps, rheumatoid arthritis and more. However, they come with some major potential side effects.

NSAIDs can Destroy Cartilage

NSAIDs (non steroidal anti-inflammatory drugs) like ibuprofen (Advil) and indomethacin may speed up the breakdown of cartilage in osteoarthritic joints. They might also inhibit tissue repair. But, not all studies show NSAIDs damage cartilage. It may depend on the specific NSAID. The best study I’ve seen to date (and also published in a very reputable journal) found older adults (a group that commonly has osteoarthritis) who used NSAIDs including diclofenac, ibuprofen, naproxen, ketoprofen and piroxican for an extended period of time had higher risk of cartilage defects and nonsignificant loss of cartilage compared to nonusers.

Osteoarthritis is very common (athletes, older adults, those who are overweight, those who have been very active their whole life) and is “wear and tear” arthritis; symptoms include joint pain and stiffness.

If you have mild osteoarthritis look for other solutions including curcumin, glucosamine and chondroitin sulfate, and boswella serrata AKBA.

NSAIDs Can Lead to Major Side Effects:

In most cases the increase in risk is statistically significant but very small (see below in blue).

  • Increased risk of heart attack and stroke. Risk increases even with short term use (1 week) and increases more with higher doses of NSAIDs used for a longer period of time.

The increase in risk is about 20 – 50% higher if using NSAIDs vs. not using them. What does this mean? If you take NSAIDs the risk of heart attack is about 1% per year. 

Aspirin does not increase risk.

  • Heart attack and stroke risk is greatest in those who already have heart disease though people without heart disease are at risk.

“Patients treated w/ NSAIDs following a first heart attack were more likely to die in the first year after the heart attack compared to those not treated with NSAIDs” (FDA).

  • Increased risk of a bleeding ulcer in the stomach or intestines. Bleeding often comes without symptoms. Bleeding could lead to death. Risk increases in those who drink alcohol, smoke, take corticosteroids and anticoagulants, those who are older and people in poor health.
  • Kidney damage
  • Liver damage; very low risk
  • Anemia; when used for a prolonged time due to wearing of the stomach lining and therefore decreased absorption of iron and / or an increase in bleeding.
  • High blood pressure
  • Central nervous system issues headache, fatigue
  • Asthma attacks in those with asthma
  • Risk of bleeding
  • Hives

Safer Use of NSAIDs

Lower your risk of harmful side effects from NSAIDs by doing the following:

  • Take the lowest effective dose.
  • Take your NSAID for the shortest possible time.
  • Don’t take more than one NSAID at a time!
  • Find other solutions for pain (see my previous and upcoming posts, especially on Instagram).
  • If you notice any other symptoms including black tar like poop, skin rashes, stomach pain, yellow skin or eyes, nausea, feeling tired, swelling or vomiting, call your doctor ASAP.
  • Call 911 ASAP if you experience any heart attack, stroke or allergy symptoms including but not limited to shortness of breath, pain in chest, arm or neck; difficulty speaking, headache, blurred vision, droopy face, swelling in throat or face.

Tylenol may be a better option though it can cause liver damage if taken in doses > 4 g per day

NSAIDs (non-steroidal anti-inflammatory drugs) might be okay for very short-term use if you have:

  • No bleeding history
  • You are well hydrated, healthy and without renal issues.

Types of NSAIDs:

There are many different NSAIDs on the market and each one has a generic name and sometimes several trade names.

Types of NSAIDs

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Keep in mind, NSAIDs are not a long-term solution to pain. Also, most NSAID safety data is not from athletes.

References:
FDA
Br J Clin Pharmacol 2010;69(6):689-700.
Ther Clin Risk Manag 2015;11:1061-1075.
Eur J Rheumatol Inflamm 1993;13(1):7-16.
J Prolotherapy 2010;(2)1:305-322.
Arthritis Rheum 2005(52):3137-3142.
Inflammation 2002;26:139-142.
Am J Med 2009;122(9):836-842.
World J Gastroenterol 2010;16(45):5651–5661.

NSAIDs Can Help Decrease Inflammation and Pain but Impact Muscle Gains

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NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen, naproxen, diclofenac, celecoxib and indomethacin can decrease pain. Take them for the shortest possible time as they can be harmful.

Should you use NSAIDs? If you must get back to work ASAP then consider the risks vs. benefits. Talk to your pharmacist and physician (MD).

NSAIDs can help decrease inflammation and pain

NSAIDs can Help Decrease Pain from:

  • Acute ligament sprain – use for < 5 days. NSAIDs reduce pain and swelling so you can return to activity faster.
  • Osteoarthritis (cartilage wear and tear)
  • Delayed onset muscle soreness. When taken for several days before muscle damaging exercise, NSAIDs may reduce soreness. Take with caution as they can wreck your strength gains (see below).
  • Muscle bruise (contusion). Short term use can decrease inflammation with no adverse effects on healing.
  • Tendonitis – reduces inflammation and helps recovery. NSAIDs may do more harm than good for chronic tendon issues.

How NSAIDs Impact your Strength Gains

  • Short-term low dose (400 mg ibuprofen) use may have no real impact on muscle strength or size.
  • Longer term, higher doses (1,200 mg ibuprofen) may compromise muscle growth and, when training was preformed with all-out max reps, strength gains were also compromised.
  • The elderly may benefit due to a decrease in inflammation from taking NSAIDs. Chronic inflammation, which is not uncommon in the elderly, impairs strength gains. NSAIDs help tame inflammation.
  • After muscle injuries, NSAIDs can help reduce strength loss, soreness and muscle markers of inflammation, particularly when lower body muscles are injured.

Why do NSAIDs Impact Training (Strength) Gains?

NSAIDs work by blocking COX enzymes. COX enzymes alter prostaglandin synthesis, mediators of inflammation and pain. Prostaglandins have other actions in the body including regulation of muscle protein metabolism. Decreases in the prostaglandin PGFare associated with decreased protein synthesis and reduced muscle fiber size. In one study, 1200 mg ibuprofen blocked protein synthesis after resistance training. Other studies show signaling responses in muscle are decreased for hours or days after resistance training when NSAIDs are used.

References:
Arthritis Res Ther 2013;15(Suppl 3):S2.
Annals of Phys and Rehab Med 2010;278-288.
Am J Sports Med 2004;32(8):1856-9.
Am J Physiol Endocrinol Metab 2002;282(3):E551-6.
Acta Physiol (Oxf) 2018;222(2).
J Physiol 2009;587(Pt 24): 5799-5800.
Am J Sports Med 2018;46(1):224-233.

 

Got Knee Pain? Creatine May Improve Your Pain & Stiffness

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If you have knee pain, chances are you may have osteoarthritis. Osteoarthritis is the most common joint disorder and it’s the medical term for “wear and tear” on a joint.  Over time, the cushioning between your joints, your cartilage, can break down causing pain, swelling, stiffness and a limited range of motion.

The initial treatment regimen for osteoarthritis often involves over the counter pain relievers, physical therapy, glucosamine and chondroitin sulfate. But, a recent study shed light on the effectiveness of a popular sports supplement – creatine, for osteoarthritis.

In a randomized, double-blind, placebo-controlled study in postmenopausal women with osteoarthritis, the women were given either creatine (in a typical dosing pattern used with creatine – 20 grams per day for one week followed by 5 grams per day thereafter) or a placebo for 12 weeks. After the 12-week study finished, physical functioning and stiffness significantly improved in the creatine group. In addition, the group taking creatine significantly improved the muscle mass in their legs.

If you are in physical therapy and working on leg and glute (butt) strength to stabilize your knee and help minimize the pain of osteoarthritis, try creatine with your program. By adding creatine, you should see greater gains in muscle tissue and see them more rapidly. And, better functioning muscle means stronger knees and less knee pain. And, you don’t need to be a postmenopausal woman to reap the benefits from creatine. In fact, you’ve got a leg up if you are under 40, especially if you are a man (because your muscle tissue is primed for growth when you are younger and men have the hormonal profile to make great gains from strength training whereas women do not have the hormones necessary to “get big”).

If you want to try creatine, take the initial loading dose in 5 gram increments four times per day or 10 grams twice a day. Take more than that at one time and you may experience some stomach distress. Is creatine safe? You bet. Check out my article here about the safety of creatine.