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seatbeltpants


Jul 15, 2010, 4:38 PM
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NSAIDs - more harm than good?
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I went for a long run yesterday and have a swollen achilles now, so was doing a little reading (as you do). What I wanted to know was whether NSAIDs actually help the user to heal faster, or if they just reduce discomfort. I came across this: http://www.caringmedical.com/...ts_injury/nsaids.asp

Can anyone out there comment on the veracity of the conclusions here, such as "NSAIDs inhibit the fibroblastic growth process and thus diminish an athlete's chance of healing. NSAIDs are used because they decrease pain, but they do so at the expense of hurting the healing of the injured soft tissue."?

Steve

ps - does this potentially apply to RICE as well?


jt512


Jul 15, 2010, 5:00 PM
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seatbeltpants wrote:
I went for a long run yesterday and have a swollen achilles now, so was doing a little reading (as you do). What I wanted to know was whether NSAIDs actually help the user to heal faster, or if they just reduce discomfort. I came across this: http://www.caringmedical.com/...ts_injury/nsaids.asp

Can anyone out there comment on the veracity of the conclusions here, such as "NSAIDs inhibit the fibroblastic growth process and thus diminish an athlete's chance of healing. NSAIDs are used because they decrease pain, but they do so at the expense of hurting the healing of the injured soft tissue."?

I can't comment on the mechanism, but, yeah, NSAIDs inhibit healing of connective tissue. You shouldn't use them at all for chronic injuries, or for more than a few days following an acute injury.

In reply to:
ps - does this potentially apply to RICE as well?

Is ice an NSAID?

Jay


(This post was edited by jt512 on Jul 15, 2010, 5:02 PM)


seatbeltpants


Jul 15, 2010, 5:09 PM
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jt512 wrote:
Is ice an NSAID?

Jay

I'd suggest that it's probably a NSAI... I guess my question is whether attempting to the reduce the inflamation through non-drug means could have a detrimental effect as well. Is the swelling of the injury actually beneficial for repair, and should we just let it do its thing?

Steve


jt512


Jul 15, 2010, 5:16 PM
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seatbeltpants wrote:
jt512 wrote:
Is ice an NSAID?

Jay

I'd suggest that it's probably a NSAI... I guess my question is whether attempting to the reduce the inflamation through non-drug means could have a detrimental effect as well. Is the swelling of the injury actually beneficial for repair, and should we just let it do its thing?

Steve

Swelling is detrimental to healing, which is why NSAIDs are beneficial during the acute phase of an injury. After that, NSAIDs do more harm than good.

Jay


hafilax


Jul 15, 2010, 9:24 PM
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jt512 wrote:
seatbeltpants wrote:
jt512 wrote:
Is ice an NSAID?

Jay

I'd suggest that it's probably a NSAI... I guess my question is whether attempting to the reduce the inflamation through non-drug means could have a detrimental effect as well. Is the swelling of the injury actually beneficial for repair, and should we just let it do its thing?

Steve

Swelling is detrimental to healing, which is why NSAIDs are beneficial during the acute phase of an injury. After that, NSAIDs do more harm than good.

Jay
Did you read the article? They claim that there is substantial evidence that NSAIDs delay healing of soft tissue even in the acute phase. I don't know enough about the topic to comment.


jt512


Jul 15, 2010, 10:35 PM
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hafilax wrote:
jt512 wrote:
seatbeltpants wrote:
jt512 wrote:
Is ice an NSAID?

Jay

I'd suggest that it's probably a NSAI... I guess my question is whether attempting to the reduce the inflamation through non-drug means could have a detrimental effect as well. Is the swelling of the injury actually beneficial for repair, and should we just let it do its thing?

Steve

Swelling is detrimental to healing, which is why NSAIDs are beneficial during the acute phase of an injury. After that, NSAIDs do more harm than good.

Jay
Did you read the article? They claim that there is substantial evidence that NSAIDs delay healing of soft tissue even in the acute phase. I don't know enough about the topic to comment.

No, I didn't read the whole article. I was basing my comments on prior information.

Without NSAIDs we're stuck with Tylenol, which is basically a non-alcoholic hepatotoxic placebo.

Jay


(This post was edited by jt512 on Jul 15, 2010, 10:51 PM)


onceahardman


Jul 16, 2010, 4:20 AM
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Thanks for sharing.

A couple problems...the cited article appears to be from an organization supporting "naturopathic" approaches to health care, prolotherapy, etc. Nothing inherently wrong with that, but it gives me pause that they are likely to be "cherry-picking" favorable results, while putting other, adverse results aside.

I'd point out that none of the research cited, for example, actually studies ibuprofen. They studies some other NSAIDS, which may or may not have similar effects.

My personal treatment philosophy is, these things make some sense. Avoid ibu during the acute and subacute phases of healing if you can. Ice is a mechanical, rather than chemical treatment, and I'd be very surprised to hear of negative effects on healing, given a very long sucessful clinical history.

My treatment philosophy differs a bit from Jay's in that I use ibu to treat my old, achy, chronic arthritic knees. I don't use it daily, and I really can't expect much healing to take place at this point, so I use it as a tool to manage pain, and allow me to pursue my work and outdoor activity.

I could not agree more with Jay, though, regarding the ineffectiveness of Tylenol. It does not do a thing for me.


jt512


Jul 16, 2010, 10:54 AM
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onceahardman wrote:
Thanks for sharing.

A couple problems...the cited article appears to be from an organization supporting "naturopathic" approaches to health care, prolotherapy, etc. Nothing inherently wrong with that, but it gives me pause that they are likely to be "cherry-picking" favorable results, while putting other, adverse results aside.

I agree that the source is suspicious. I'm particularly skeptical about the claim that NSAIDs should be avoided during the acute phase of an injury. I hadn't heard that before. NSAIDs are widely prescribed for acute injuries, the belief being, as I understand it, that the benefit to reducing inflammation is greater than the harm to the healing process in the short term. What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

In reply to:
I'd point out that none of the research cited, for example, actually studies ibuprofen. They studies some other NSAIDS, which may or may not have similar effects.

The effects are probably similar. All NSAIDs inhibit production of COX-1 and COX-2, the enzymes responsible for the production of eicosanoids that mediate healing processes.

In reply to:
My treatment philosophy differs a bit from Jay's in that I use ibu to treat my old, achy, chronic arthritic knees. I don't use it daily, and I really can't expect much healing to take place at this point, so I use it as a tool to manage pain, and allow me to pursue my work and outdoor activity.

I use ibuprofen, too. I have arthritis in a toe from an old injury. And sometimes, without ibuprofen, the pain is too great to climb. But, like you, I avoid using ibuprofen daily, as I'm concerned about what the consequences to the health of my tendons would be.

Jay


onceahardman


Jul 16, 2010, 2:45 PM
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Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery. When you are a PT, you tell people they need to exercise differently. When you are a chiropractor, you tell people they need their back cracked (or, they need to reduce a "vertebral subluxation complex").

When you are a hammer, you see the world as a nail.


serpico


Jul 16, 2010, 3:14 PM
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So the least nsaid, soonest mended?


reno


Jul 16, 2010, 3:25 PM
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serpico wrote:
So the least nsaid, soonest mended?

That should go uNSAID.


jt512


Jul 16, 2010, 3:25 PM
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onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay


onceahardman


Jul 16, 2010, 3:36 PM
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serpico wrote:
So the least nsaid, soonest mended?

To be wisely applied to this thread, immediately. Smile


onceahardman


Jul 23, 2010, 3:51 PM
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jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery. That is what surgeons do.

The fact he/she did not cut you open does not change the fact he/she makes a living cutting people open.

PS, by not doing "open" surgery, are you implying another technique was used, like, say, arthroscopic surgery, joint injection, closed reduction, etc? Or was the surgeon's capacity purely advisory?


jt512


Jul 25, 2010, 10:35 PM
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onceahardman wrote:
jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery.

It appears that you should familiarize yourself with the subject of medical ethics, considering you're in a related field an whatnot.

Jay


onceahardman


Jul 26, 2010, 3:56 AM
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jt512 wrote:
onceahardman wrote:
jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery.

It appears that you should familiarize yourself with the subject of medical ethics, considering you're in a related field an whatnot.

Jay

Now there is a fairly classic non-responsive answer.

I'm quite familiar with medical ethics. Perhaps you think the reason surgeons get board certified in orthopedics is so they can give out cheap advice. If so, you need a dose of reality.

How about an answer to my other question, regarding your implication of some other technique in lieu of "open" surgery? And please keep it honest, since you have such concern about ethics.


jt512


Jul 26, 2010, 6:56 AM
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onceahardman wrote:
jt512 wrote:
onceahardman wrote:
jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery.

It appears that you should familiarize yourself with the subject of medical ethics, considering you're in a related field an whatnot.

Jay

Now there is a fairly classic non-responsive answer.

I'm quite familiar with medical ethics. Perhaps you think the reason surgeons get board certified in orthopedics is so they can give out cheap advice. If so, you need a dose of reality.

How about an answer to my other question, regarding your implication of some other technique in lieu of "open" surgery? And please keep it honest, since you have such concern about ethics.

I'm not interested in discussing the subject with you. Your comments have reinforced an image I formed about your idea of medical ethics when you once referred to physical therapy as your "business" rather than your "practice." Good thing you didn't go into surgery.

Jay


onceahardman


Jul 26, 2010, 11:12 AM
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I didn't think so.


onceahardman


Jul 26, 2010, 2:38 PM
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jt512 wrote:
onceahardman wrote:
jt512 wrote:
onceahardman wrote:
jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery.

It appears that you should familiarize yourself with the subject of medical ethics, considering you're in a related field an whatnot.

Jay

Now there is a fairly classic non-responsive answer.

I'm quite familiar with medical ethics. Perhaps you think the reason surgeons get board certified in orthopedics is so they can give out cheap advice. If so, you need a dose of reality.

How about an answer to my other question, regarding your implication of some other technique in lieu of "open" surgery? And please keep it honest, since you have such concern about ethics.

I'm not interested in discussing the subject with you. Your comments have reinforced an image I formed about your idea of medical ethics when you once referred to physical therapy as your "business" rather than your "practice." Good thing you didn't go into surgery.

Jay

Description of Ad Hominem
Translated from Latin to English, "Ad Hominem" means "against the man" or "against the person."

An Ad Hominem is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting the claim or argument. Typically, this fallacy involves two steps. First, an attack against the character of person making the claim, her circumstances, or her actions is made (or the character, circumstances, or actions of the person reporting the claim). Second, this attack is taken to be evidence against the claim or argument the person in question is making (or presenting).


tomtom


Jul 26, 2010, 4:54 PM
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jt512 wrote:
onceahardman wrote:
jt512 wrote:
onceahardman wrote:
Hi Jay, it's really nice to be in agreement with you.

This, from you,

In reply to:
What they are claiming about chronic use, however, is uncontroversial—again, as I understand it, based on my own research of the literature and conversations with several orthopedists.

I think, is the only possible misunderstanding. To clarify, I was not talking about chronic use of NSAIDs, but the (hopefully limited) use of NSAIDs for chronic injuries. (rather than acute or subacute injuries.)

Regarding your conversations with orthos (and perhaps other MDs), I agree, they prescribe NSAIDs a lot for acute injuries. When you are a medical doctor, you prescribe medicine. When you are a surgeon, you prescribe surgery.

That's an oversimplification. I've been to several orthopedic surgeons for several sports injuries, and never did they perform open surgery.

Jay

It may have been a simplification, but I don't think it's an oversimplification, based on your single case.

Surgeons make a living cutting people open, not giving advice. Your surgeon made little or no money advising you, but would have made thousands doing surgery.

It appears that you should familiarize yourself with the subject of medical ethics, considering you're in a related field an whatnot.

Jay

But there's always the medical ethics conundrum that drug and device companies put huge amounts of money into marketing directed at practicing doctors, but medical ethics say that doctors are not influenced by this money.

Studies show that the more money a doctor receives from a drug company, the more likely they are to prescribe products from that company.


ClimbClimb


Jul 26, 2010, 5:38 PM
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jay & onceahardman -- can't we all get along? it was so nice when you two were agreeing earlier in the thread; O -- if J doesn't want to discuss the details of his orthopedic interventions in this thread, I think that's fine... :-)

NSAIDs -- my guess is that in 20 years we'll learn, as is often the case, that "it depends" a lot on how prone to inflammation your body is, the extent of the injury and lots of other parameters whether NSAIDs are helpful or harmful to repair and long-term function. THe one thing that's pretty clear is that loading up on grams of "vitamin I" and then continuing to do what caused the tendenopathy in the first place is not the right answer.


jt512


Jul 26, 2010, 5:51 PM
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ClimbClimb wrote:
jay & onceahardman -- can't we all get along?

No, I don't think we can. I've come to the conclusion that it would be best for him and me to just agree that we don't like each other very much, and move along.

Jay


onceahardman


Jul 26, 2010, 6:19 PM
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In reply to:
jay & onceahardman -- can't we all get along?

I'm sure I can. You'll note it was I who offered the olive branch above.

I don't actually dislike Jay. I agree with the majority of what he writes on these forums. He's a smart guy.


reno


Jul 27, 2010, 7:12 PM
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jt512 wrote:
I'm not interested in discussing the subject with you.

Of course not.


domnas


Jul 28, 2010, 6:13 AM
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yeah leave disliking jay to everyone else on this forum.

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