One of the most frequently asked questions in practice is “should I be taking anti-inflammatory or pain medication to help with my injury?” Unfortunately there is not one answer that fits all when it comes to this question. Having a basic understanding of the mechanism of how our body responds to injury and in turn how pain killers and non-steroidal anti-inflammatory medications work -is important in helping you make the best decision on what is right for you.
Whether it is bone, tendon, ligaments or muscle – when we first injure ourselves our body’s immune system responds by sending in an arsenal of inflammatory mediators (chemicals, enzymes platelets etc) to the site for repair. These cells begin the process of cleaning the damaged tissue followed by laying down new cells in order to “Bridge the Gap” at the damaged site. This inflammatory response attracts fluids to the area (such as white blood cells) in addition to the fluid leaking from the injury site into the surrounding tissue. This build-up of fluid is seen as the characteristic redness, swelling and warmth of “inflammation” in the area. As the fluid around the injury builds, the pressure spreads to the local nerve endings triggering pain signals to your brain. The larger the build up of fluid in the area the greater the number of nerve cells triggered and thus the more pain you feel. Controlling this pressure and fluid build up is key to reducing the pain signalling mechanism and aiding in the speed of recovery.
Basically, both anti-inflammatory and pain killers (called an analgesic’s) use chemical mechanisms to reduce the inflammatory sequence or inhibit pain signals to the brain. These chemical mechanisms do little to aid the actual healing process and is why the RICE acronym (see below) has been developed to aid in the natural flow of healing. Together, the combination of both drug and aided natural processes with RICE can be the best of all. Either way, the safest rule when taking any medication, is to seek individualized advice from your health professional.
How RICE works in aiding the natural process
Rest: Avoid any aggravating movements where possible. This prevents further injury and slows the fluid accumulation process.
Ice: Cold water immersions and Ice packs causes vasoconstriction. This is where blood vessels in the area shrink which slows the amount of fluid that can arrive at the site – which in turn diminishes pain signals to the brain.
Compression: Tape, braces or bandages effectively compress the area forcing dispersion of the fluid accumulation to a greater surface area of tissue around the injury site. This greater area of dispersion allows the body to filter the excess away more rapidly.
Elevation: Uses gravity to assist drainage of excess fluid at the injury and better allows the recirculation systems to move the fluid.
How non-steroidal anti-inflammatory (NSAID’s) and Pain medication (Analgesics) work
Most NSAID’s such as Nurofen, Voltaren and Celebrex work by reducing the inflammatory signalling process. This is done by blocking the inflammatory pathways that produce the enzymes (and in turn inflammatory chemicals) that are needed in the recovery from illness or injury. They are good for providing short term relief from sport related injuries such as strains, sprains or during and after competition. However, it is not recommended that NSAIDs be used for an extended period of time, because although blocking signalling processes may lead to short term comfort the inhibition of the natural process delays actual healing which could potentially lead to further damage over time. Furthermore, when taken correctly anti-inflammatory drugs are safe however prolonged use has been known to lead to gastrointestinal issues, kidney damage and even stroke/heart attack in extreme cases. So typically less is best when using NSAID’s.
Panadeine, Panadol and Codeine are the most commonly used Analgesics drugs. These painkilling drugs act on nociceptors (pain receptors that signal pain to the brain) by interfering with the messaging processes. These drugs are best used for generalized moderate to severe pain or chronic conditions such as arthritis where constant pain can limit the normal function in day to day life. Taking these over the counter drugs occasionally and as advised by your health professional are generally safe and will typically help reduce your pain and discomfort. However, it is important to remember the altered pain ‘perception’ may improve your daily function but it has little effect in aiding in the actual healing process. Furthermore, (as with Anti-inflammatories) there are negative side effects to prolonged analgesic drugs including the potential for liver damage, constipation, stomach ulcers and kidney dysfunction. Advice from your health professional should be sought if long term use is required.
Other drugs like Ibuprofen work on both mechanisms mentioned above, however most drugs simply do one or the other. For example, Codeine is a good analgesic but does little for inflammation, where as Celebrex is a powerful anti-inflammatory but has little influence on the pain pathways. So having a trained professional identify the most likely form of pain you are suffering from can help guide you to the best form of medication to use in conjunction with the RICE and hands on methods of treating your injury.
As you can see the correct use of both painkillers and Anti-inflammatory drugs are safe, and have their role to play in our recovery. Yet it is also clear that they should not be the only approach and when used should be tapered/avoided over the long term. Having a rounded approach that adopts medication (used in conjunction with liaising with your doctor) and a treatment plan dedicated to naturally reducing inflammatory build-up of fluids through the RICE – followed by a tailored musculoskeletal rehabilitation plan to build strength and confidence again is a safe, natural way to treat and manage injuries for good.
For more information on different medications, treatments, or to book an appointment contact us on 90174784.