Indication
NSAIDs comprise a large group of substances that all have analgesic, antipyretic and anti-inflammatory effects. The effect starts quickly, but is only maximised after a few days of treatment. Studies have not been able to prove that treatment with NSAIDs has any effect on the healing of muscle, tendon or ligament injuries.
NSAIDs have a very limited place in the treatment of sports injuries. As with all painkillers, there is a risk that the athlete will accelerate rehabilitation too quickly when pain is reduced, increasing the risk of relapse and aggravation.
Side effects of NSAIDs
Gastrointestinal side effects (acid reflux, heartburn and stomach ulcers) are common after NSAID treatment. Ulcer bleeding can be fatal. There is an increased risk of blood clots with long-term treatment. Hypersensitivity shock, kidney damage, bone marrow damage have been described but are rare. Only modest side effects are seen after localised treatment (gel) with NSAIDs.
Contraindications
In healthy athletes, allergy is virtually the only contraindication for NSAID treatment. In patients with stomach ulcers, high blood pressure, liver, heart and kidney disease, caution is advised with NSAID treatment. Prolonged treatment is not recommended by the Danish Health Authority.
Administration
Tablet therapy is recommended. A few placebo-controlled studies suggest that topical NSAID gel is safely superior to placebo in acute injuries, although blood concentration after topical treatment is only less than 10% of the level after tablet treatment. There is no scientific justification for using injections. There are no scientific studies documenting the ideal time to start and duration of NSAID treatment.
Discussion and debate
It is not definitively clear whether inhibiting acute ‘inflammation’ (inflammation) is an unconditional benefit. Pain and discomfort are partly conditioned by the ‘inflammation’. By reducing the ‘inflammation’, symptoms are reduced and there is a risk that rehabilitation is accelerated too quickly resulting in relapse and worsening of the injury. On the other hand, inflammatory cells are responsible for the breakdown of damaged tissue, which is necessary for the removal of dead muscle fibres and the like.
Conclusion
If analgesic treatment with NSAIDs is indicated, the lowest possible dosage is recommended to reduce the risk of side effects. NSAIDs are available over the counter, but their use should be discussed with a professional with in-depth knowledge of the drug and basic rehabilitation principles.
