Ibuprofen risk

[Anonymous]

A friend sent me this article, and I found it interesting enough to put it out here for those of you who routinely take Ibuprofen before and after exercise. Maybe time to reconsider….

http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/

[Brian UL]

If you need to take Ibuprofen to exercise you need to reconsider your exercise! thats crazy

[Luke Schmidt]

I don't use pain killers long term, I see them as more of a one shot deal do get me out of a situation. If I'm taking them often I'm doing something wrong.
I can't prove it but I'm pretty sure pain killers saved my bacon on two different occasions. In one case various factors conspired to where I really needed to do a long day. It was going to be a suffer fest one way or the other but I really think a hefty dose of Ibuprofen helped. Another time I'd pulled a muscle, or a rib or something but I had a very sharp pain in one small area of my back. Since my pack just happened to make contact there it was about to ruin a trip. I took a dose of Advil and about 30 minutes later I felt much better.

[Rex Sanders]

Briefly mentioned in that article:

"Animal studies have also shown that ibuprofen hampers the ability of muscles to rebuild themselves after exercise."

Ten years ago, I was training for a 500 mile hike, and taking Aleve (naproxen sodium, another NSAID), before and after hikes for muscle soreness, but couldn't get past 13 miles per day.

I read about the muscle rebuilding problem, so stopped taking Aleve.

In two weeks, my hiking strength increased, and my soreness decreased. Along with other changes, I was hiking 20+ mile days a couple of months later.

I still get sore after hiking, but I've learned that stretching immediately *after* hiking, prevents soreness the next day.

"No pain, no gain" is true for me!

Now, I take Aleve or related drugs only for injuries or illness.

YMMV.

(Edit for typo)

[Bob Gross]

The other risk is that Ibuprofen and Tylenol require you to drink a fair amount of water with the pills. Most distance runners do not carry such a huge amount of excess water, so they simply take the pills with a mere sip. That causes distress in the kidneys. If you are taking a lot of Ibuprofen and Tylenol during some event, you can cause your kidneys to shut down. Competitors in the Western States 100 Miler routinely run into this problem. Intravenous fluids generally don't fix it, and kidney dialysis will. Through-hikers surely don't want to get into this mess.

–B.G.–

[Alex H]

In this related article from a few years ago it basically says what Rex discovered as to it not letting the body actually rebuild itself. I now only take it when I actually hurt.

http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/

[Hiking Malto]

I have taken way more advil then I probably should especially during my thru hike. On my thru it was the only thing that made the pain in my feet bearable, and it in a similiar situation I would likely do it again. I don't take any Advil during normal routine training. If you need to take it to train it likely means your body needs a rest. The times that I still take it is late into a long mile day generally if I know I have to make it a certain distance by days end. I no longer take in just to get miles, again it means that I'm pushing myself harder than I should. I also will take a single dose if I feel inflammation in my feet or ankles at the end of a long hike. I view this as preventive and since the frequency is less than once a week I'm not too concerned with it.

I am not a bit surprised at the high percentage of serious runners that take Vitamin I daily. Excersise for many of these folks, and me included can be an addiction, though generally a healthier addiction than most. If popping a couple of pills allows us to get their fix then so be it. Hopefully I will avoid doing it again.

[Eugene Smith]

I'm surprised by the survey figures. 70%!?

That seems steep. Who knew so many people treated ibuprofen like a maintenance drug.

A few years ago I habitually took ibuprofen to bring down the pain from an ongoing IT band injury. It was in desperation and impatience to get back to running that I resorted to NSAID for pain management. Eventually, the ibuprofen didn't help much with the pain, nor the inflammation, even popping 800-1000mg at a time to get through a short run. It was all very stupid and dangerous. I eventually resorted to cross training, rest, and time, which helped me get back to running when my body was ready.

So many recreational endurance participants treat themselves like elite athletes, biting off more than they can chew, taking on too large of a training volume too quickly, and their unaccustomed bodies take a beating. Ibuprofen as a training tool is just foolish.

[Sarah Kirkconnell]

I rarely, rarely take painkillers. Of any kind.

Partially why is for 4+ years I was on blood pressure meds that were not compatible with Ibuprofen (how many people go the gov'ts website and actually read up on what meds to not mix??) So I got used to sucking it up. And I found that most pains were better once I got moving – or if a migraine, rest.

Being sore is something I can deal with – I developed carpal in BOTH hands in my last 2 months of pregnancy last winter, with my 3rd son. My hands/arms hurt nearly every day still. You get used to it. I work out through that pain and do get very sore…but again, I know the soreness of working out fades quickly.

Then again….I have delivered 2 sunny side up babies so I know what true pain feels like. Nothing and nothing will block that pain. Muscle soreness from walking or running too many miles is like nothing compared to a 10.5 lb baby!! Really. I cannot think of ANY outdoor activity that even came close to that in my life. Even a 30 mile day would be easy compared to that.

[Marc Eldridge]

I did hard physical labor for quite a few years of my life. Sore muscles were just part of the game and I never took anything for it. It really didn't hurt that bad and after you went back at it the next day the soreness went away. Soreness in the muscles was one thing but the aches I developed in the joints, particularly the knees, as I got older was another. The orthopedic surgeon suggested some options one of which was 600 mg ibuprophen 3 times a day. I started this as a regimen and was amazed how at first it almost completely took away the pain. I did this for quite a few years usually only taking it 2 times a day. I kept hearing about gastric distress as part of taking it and after some more years decided I would only take it at need when I was actually doing something physically demanding. This is how I use it now and I feel the benefit outweighs the risk at this point. As an aside, at the same time I started the Ibuprophen I started glucosamine/chrondroitin which I have been taking continuously and feel it helps.

[Mike M]

I very infrequently take ibuprofen, the study they did w/ some of the Western States runners was convincing enough that it wasn't worth taking as a preventive measure, I will take some occasionally if I'm really (really) sore from a long run

it's a staple in my first aid kit, but they don't get used much

[Franco Darioli]

"how many people go the gov'ts website and actually read up on what meds to not mix??

Doctors are having problems with patients not disclosing they are taking herbal medicine.
A popular fallacy is that because herbs are "natural" they can't hurt…
well…they can

[Sarah Kirkconnell]

Yep on that Franco…..

I love that my Doctor is part of a large system and everything is online – so no matter who I see, they see what I take. And every visit I am given a print out of my meds (prescription and other) to go over and update. They actually ask about pain killers as well!

[jscott]

I used Ibuprofen for what I now realize is arthritis pain. Geeze, I can deal with muscle soreness. Arthritis pain in my left ankle and right knee is what I was hoping to treat and alleviate. So I've finally tried acetomophin, the over-the-counter arthritis drug. It seems to work. Now I'll wait to hear about the side-effects of acetomophin!

And yes, I'm doing exercises to strengthen those areas of my body, and indeed they've helped a lot!

Actually, there are certain drugs with millions of users over decades of use–the statins come to mind, which treat cholestoral–that don't have red flags all over the place telling you to stop. Sometimes pharmaceutical drugs can be safe and beneficial.

Maybe the problem is that the pharmaceutical industry and it's often disgusting and profit-driven practices has so lost the trust of the general population that even long-standing products seem suspect. We hate and distrust the industry as a whole because we so often see that they effect great harm to people without any compunction if it means that they turn a profit. We know that they're gouging us; how can they have our well-being in mind?

Sorry for the drift.

[obx hiker]

My most persistent symptom of "altitude adjustment" is a pronounced lack of appetite. I couldn't help but notice this paragraph from the NY Times article linked by Tom K.

"Physiologically, it makes sense that exercise would affect the intestines as it does, because, during prolonged exertion, digestion becomes a luxury, said Dr. Kim van Wijck, currently a surgical resident at Orbis Medical Center in the Netherlands, who led the small study. So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood, some of the cells lining the intestines are traumatized and start to leak."

This part was intriguing: So the blood that normally would flow to the small intestine is instead diverted to laboring muscles. Starved of blood,

And might that be compounded by the effect of altitude on the transport of oxygen by the bloodstream…… exaggerating the effect……. with the blood "diverted to laboring muscles" lacking in oxygen?

Might be a good idea to forego the vitamin-I as a prophylactic against altitude adjustment headaches.

[Lynn Tramper]

Ibuprofen also reduces your ability to repair and make new cartilage. So people who are advised to take it for osteo-arthritic pain get a two-edged sword. It temporarily makes the pain more bearable, but longer term can make the disease worsen. Some of the newer COX2 inhibitors are less likely to have this effect, so I would suggest those needing pain relief for arthritis consider swapping to one of these.

[jscott]

Thanks Lynn I'll look into the cox2 inhibitors. AND into the whole prophylactic use thing. I've heard contradictory things about this concerning ibuprofen.

[Roger Caffin]

> We know that they're gouging us; how can they have our well-being in mind?
It puzzles me that you should ever imagine that they have any other objective than making a profit for the executives and their shareholders. That is what the law requires.

HOW they make that profit – that varies from industry to industry. Some make drugs, some make weapons, some make cigarettes, some …

Cheers

[Anonymous]

"Thanks Lynn I'll look into the cox2 inhibitors. AND into the whole prophylactic use thing."

I'd avise approaching COX2 inhibitors very carefully, Jeffrey. Celebrex, the most popular one now comes with a "black box" warning, due to troubling indications of sudden death from heart failure as well as its potential for serious GI bleeding. I was on Celebrex for 8 years, and finally got off it as the data started coming in and my stomach started reacting. It is also very expensive. That said, it is very effective as a pain killer and anti inflammatory. At the very least, have a good heart to heart with your doc.

[Jennifer Mitol]

First of all, no NSAID will "interfere" with cartilage healing or worsen osteoarthritis, because cartilage doesn't heal…it has no blood supply and once it is damaged that damage is permanent. We don't even have good ways to surgically repair it yet.

And COX-2 inhibitors burst onto the market a few years ago (Celebrex, etc) with great fanfare because we thought they would not harm the stomach lining (which is COX-1). The newer class of NSAIDs would supposedly block inflammation without harming the proteins that create the lining of your stomach. Unfortunately it didn't work that way…the COX-2 NSAIDs were just as bad for your stomach as the older versions, and seemed to actually have worse cardiac risks.

As for acetaminophen, be VERY careful. Is is NOT a safe drug actually. One of the pharmacists I work with says today it would never be granted over-the-counter status because of its side-effect profile. It is the leading cause of non-alcoholic related liver failure. Watch how much you take and do NOT go over the 2g/day limit. Ever. It can kill you.

And statins?? Of course they have serious side effects, one of which is a very serious condition called myositis. In fact, many of my patients are hospitalized for severe muscle pain reactions to taking them.

There is no such thing as a drug without serious side effects. You can't expect to alter your physiology in one area of your body's ecosystem and not have an effect elsewhere. Sometimes it's not a big deal and you won't notice it…but many, many times you do. Everybody's different…

That will be your medical/physiological/pharmacological lecture for today.

[Roger Caffin]

> As for acetaminophen, be VERY careful. Is is NOT a safe drug actually.

And don't go around handing out NSAIDs to other people either. Read the fine print on the packet for a basic Aspirin: it is contra-indicated for some people.
Translation: two tablets can kill some people by inducing an allergic reaction which can shut down the air channels to the point of asphyxiation and death.

It happens.

Cheers

[John S.]

Prolotherapy paper about NSAID risk
http://www.journalofprolotherapy.com/pdfs/issue_05/issue_05_10_nsaids.pdf

American College of Rheumatology guidelines
http://www.rheumatology.org/practice/clinical/guidelines/ACR_2012_OA_Guidelines.pdf

Jennifer, what does the PT world think of prolotherapy?

[John Donewar]

A little pain can be a good thing. All of these OTC and Rx meds have their different side effects. I had never heard of Cox-2 inhibitors before this thread and when I read up on some of the side effects and possible complications I decided to stick with what has worked for me in the past. I have also decided to try and let my body's natural endorphins handle any discomfort as much as possible. I'll save the "meds" for when I really hurt!

Click the link below and then scroll down to the area describing the side effects and complications.

http://www.aws-law.com/cox-2.asp

I expect nothing short of a few good natured jokes about the source of this link.

And now here for your entertainment is a short video clip to illustrate the first line of this post.

http://www.youtube.com/watch?v=g1Bd5DhItKQ

Don't you just love the white socks and the shorty shorts? L O L

Party On,

Newton

[Jennifer Mitol]

What does the PT world think of prolotherapy??

Well, that's a bit of a loaded question with many answers ;)

First of all, there are no good, peer-reviewed (in high-impact journals) randomized controlled trials that show that it is effective. This is why insurance companies won't cover it.

Many people and clinicians swear by it…but so far I have yet to be convinced. Treating tendon pathologies is very difficult, again because of a lack of good blood supply and a rather significant lack of understanding as to what is actually wrong with the tendon itself. We used to like to inject cortisone into them (and unfortunately some clinicians still do that…) thinking that it was "inflamed," which it is not. Numerous biopsies and histological studies have found NO inflammatory cells…the tendons seem to degenerate for some reason.

The idea behind prolotherapy is to actually induce a bit of inflammation into the tendon to kick start a healing process…which in theory is still somewhat iffy because we don't know why the tendon degenerates in the first place. PTs used to use aggressive, painful massage to try to increase blood flow for the same reason, with no demonstrable effects (except for my favorite: I KNOW it works…)

I think there is a lot of work going on to figure out how to deal with tendinopathies and if you can easily afford to pay for prolotherapy, and none of the other treatments (particularly eccentric loading exercises) have helped, then by all means give it a try. Its certainly better than having sie orthopod hack away at your tendons. I'm a little skeptical that the big prolotherapy groups haven't submitted their work to high-impact journals for good peer-review though.

And I have to point out, as a strong evidence-based practitioner, that the placebo effect can be as much as 75%, which only increases if you paid a lot of money for a treatment (just as people think higher priced wines taste better, they think the more they paid for a treatment the better it must be…)

There is a reason randomized controlled trials are the basis for evidence-based medicine. It is very easy to see "your" patients getting better with a treatment, or you had a good result, or your friends did…but until you compare it to good controls you really can't know if it really is more effective than that wonderful placebo.

[John S.]

That is what I thought, possible snake oil injections ; ). That paper by the prolotherapy "journal" looks all official (and the content may have some truth) but sorta comes across as a commercial since it is not in a mainstream journal. The placebo effect is an amazing thing.

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