NSAIDs In Acute Pain

Non-steroidal anti-inflammatory drugs (Advil, Naprosyn, and the large over-the-counter, so-called NSAID

family) are probably the top category of drugs used in the US.

There is a problem with that. I’ll address the short-term use today and I’ll return for a second shot at its

long-term (mis)use.

A study investigating NSAIDs for acute pain showed a surprising increase in the percentage of patients

who progress to develop chronic pain when compared to those who didn’t receive this treatment. But it

makes sense. Any acute injury to our body (especially trauma and surgery), will trigger inborn

mechanisms of defense and repair that are truly amazing in their complexity and elegance. We are made

to heal, repair, and recover. In short, we are born survivors. Inside us, we have the best doctor,

therapist, and coach we’ll ever encounter.

The initial injury creates an acute inflammation, which is an immediate and positive reaction mobilizing

armies of cells acting as defenders, soldiers, EMTs, scientists, and planners who set up to repair the

injured part right away. In a way, there is no chance of repair without the initial step of inflammation.

Unfortunately, widely used NSAIDs are powerful inhibitors of this process, and while they prevent the

acute inflammatory process, little is known of their limited power to promote healing (probably

minimal). It is possible that an incomplete repair process may start a chain of events leading to the

development of chronic pain. Maybe at this point, all we need is to get out of the way, rest a bit, and

allow the miracle of creation end evolution to take its course. Tolerating some degree of pain and

understanding it is a signal our bodies are starting to work should be the initial step in the recovery

process. Acetaminophen (Tylenol), ice, a short period of rest, and limited, carefully monitored use of

minimal doses of opioids (none of which interferes with the repair process), just enough to allow

progressive return to activity (which turbo-charges healing) may be a wiser solution if the rules of this

process are thoroughly discussed and agreed upon with patients before its initiation.

Take good care of yourself!