I read a great article in the May 2011 issue of Consumer Reports of Health, pg 8 and 9. The article was titled Choosing and using pain relievers and discussed the popularity of anti-inflammatory drugs as well as the risks. I am sure that no athlete is immune to the benefits of ibuprofen and Aleve. I know for myself I had a few ibuprofen with me during my first IM. Not knowing what "it" would feel like to participate in an IM, I forgot to take the ibuprofen and learned (after 3 more Ironman's) that no pain reliever is going to alleviate pain during an Ironman....an IM hurts no matter what and taking pain relievers are not practical solutions to reducing inflammation and soreness during the race. When it comes to anti inflammatories, some athletes have resorted to powerful anti-inflammatory drugs, such as glucoroticoids (prednisone, dexamethasone, hydrocortisone) which strongly inhibit the inflammatory response. However, prolonged glucocorticoid use may have adverse side effects such as immunosuppression, fluid shifts, brain changes, and psychological changes. Not to mention an increase in blood glucose levels (often causing a person to be temporarily diabetic) and may suppression in calcium absorption.
One thing athletes may want to consider when reaching for glucocorticoids for inflammatory purposes (ex. a few weeks prior to a race or in the peak of training for an event) is that they may interfere with the tissue building, anabolic processes. Not to mention a reduction in bone density, weight gain due to increased visceral fat deposition (central obesity), appetite stimulation and immunosuppression.
Now I'm not saying that a person should not take take anti-inflammatories but I think we should be careful when we consider drugs as the immediate cure-all to preventing and reducing risk for injury. Sometimes we need to sit back and look at the bigger picture of training and racing for health, longevity and fitness rather than for an immediate endorphin-boost or because of the feeling of lack of control when it comes to eating for fuel.
Although 2 daily Aleve's were part of my daily routine for the first 10 days of my hip flexor strain, it was important that I focused on the reason behind my injury and not just trying to rush the healing process and not solve the issue behind the problem. I did not attempt to do anything during those first few days which would make my problem worse so I was sure that the Aleve meds were not masking pain so that I could "push through" pain. Whereas I was once a stubborn athlete, I no longer train with pain. I NEVER want to get through a workout but rather, make the most out of my workout.
I believe that it's perfectly acceptable if you want to take an anti-inflammatory every now, especially if you are extremely inflamed or if your problem is disrupting daily functions of life (sleeping, work, family time). But of course, you want to get to the root of your daily problem for wanting/using the pain reliever and then seek out the MANY other ways to reduce inflammation (epson salt baths, compex muscle stimulator, foam roller, stretching, massage, active recovery, good nutrition) which you may find useful on a daily basis. As for reaching for the pills, I don't know what I would do without Tissue Rejuvinator from Hammer as part of my daily build/peak season training routine.
How do NSAIDs work?
(from the article)
They fight pain by targeting one or both of two enzymes COX-1 and COX-2. These enzymes are crucial for the production of hormones called prostaglandins that trigger inflammation, which in turn sends pain signals to the brain. At high enough doses, NSAIDs can inhibit inflammation and thus thwart pain.
But blocking COX-1 also leaves the stomach vulnerable to ulcers and bleeding, since the enzyme makes prostaglandins that help protect the lining of the stomach from acid. In fact, 5-10% of NSAID users experience ulcers or bleeding in a given year.
Newer "selective" NSAIDs such as Celebrex (celecoxib) were developed with the aim of reducing gastrintestinal side effects by blocking COX-2 more than COX-1. Celecoxib does appear to cause less stomach discomfort than other NSAIDs, and a few studies of short-term use found it caused fewer serious ulcer complications. But a major study that compared Clebrex with two older NDSAIs -ibuprofen (Advil and generic) and diclofenac (Cataflac and generic) - over a year found that it was no less likely to cause serious ulcer complications. And there's no conclusive evidence that Celebrex carries a lower long term risk of serious stomach problems in general.
What's more blocking COX-2 over time can lead to a higher risk of heart attacks and strokes, though why this remains unclear. Higher than acceptable rates of those events led to the withdrawal of two COX-2 inhibitors, rofecoxib (Vioxx) and valdecoxib (Bextra) in 2004 and 2005, respectively.
There is no evidence that any NSAID relieves pain more effectively than others at equivalent doses. But some people get more relief from one NSAID than another, so if one doesn't work for you, try another. Based on cost and effectiveness, Consumer Reports Health Best Buy Drugs recommends that people who need a prescription NSAID start with either generic ibuprofen or generic naproxen. They can cost as little as $4 for a month's supply at chain stores like Target and Walmart, and possibly even less per a month if you get a 90-day supply.
With any NSAID, take the lowest dose that brings relief, don't exceed recommended doses (especially if you take it regularly), and don't take it for long periods without consulting a doctor. Stay alert for signs of stomach ulcer: burning stomach pain and bloody, black or tarry stools. Tell your doctor and pharmacist about other medication or supplements you take, since NSAIDs can interact with other treatments.
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