Should I take an anti-inflammatory? I work my regular paying job at Immediate Care/Occupational Medicine Clinic and the first thing we prescribe is an ibuprofen 200mg (3 tabs) 3xdaily for the life of the injury. There are some orthopedic surgeons that say don't interfere/reduce the inflammatory process that follows injury because it slows down healing of the injury. This thinking is based on the fact that a "normal healthy person", should be able to mount a response to halt inflammation and reverse the injury (assuming no further damage is added). Problem my orthopedic surgeons forget is that the inflammatory cascade that gets triggered with the smallest microscopic fiber exposure (torn fiber from a muscle, blood vessel, skin, bone....) starts a local reaction in addition to a systemic reaction. Those of you who are fibromyalgia sufferers, or chronic arthritis patients will know of how the rest of the body "kills" when you have only injured one joint.
The surgeons get to see the inside of joints that have been injected with steroid (cortisone) and they hate it. You can't repair mush after 'roids have been used and expect a good outcome for the graft you are inserting for rebuilding an ACL. So for the few joints that have multiple injections prior to surgical consult, I agree with the specialist. For the millions of others that suffer countless nights not being able to sleep, not being able to walk, where every minute of every day is "I am in pain"; I think relief is worth it. I would use over the counter anti-inflammatory first (just because anything over the counter is considered a "non-reportable" therapy-so employers don't have to claim it on insurance) but quickly go to prescription anti-inflammatory within 10 days if the first didn't work.
The proper use of NSAIDS is to start with minimum dose at the interval of when the med will wear off. ( For aleve/naprosyn it would be twice a day; for ibuprofen/advil/motrin it would be three times a day) After 10 days if no response, increase to maximum dose of that same NSAID. After 10 more days with no pain/inflammation control we switch to different NSAID - I usually go for the prescription meds....I rely on the older ones that were around from when I did a Sports Medicine fellowship in the 90's (nabumetone, etodolac, meloxicam.....or older ones like clinoril, indocin, mefanemic acid). I have alot of options but most people would throw hands in the air if pain/inflammation isn't controlled by 2nd visit. Usually it's 2 diff NSAIDs and if no response, time for a burst of prednisone. OOOOHHH the "P" word!!!
Yes, in some cases prednisone is necessary for controlling inflammation before we have spasm from compensating during walking, or trigger points flare up, or distant joints flare up due to the overall inflammatory response being turned on. Only 1 time in 20 years have I had weight gain in a patient given 5 days. There is also no literature that says steroid use for 5 days or less needs a taper (to prevent Addisonian Crisis) so when we give the medrol dose pak-6 days of decreasing dose.....it is a waste of 3 submaximal doses. Usually there is insomnia (thus the reason for morning dosing with my 3 tabs of prednisone for 5 days). It can also raise blood sugar for my diabetics.
If the inflammation is not acute, I would highly suggest Turmeric in capsule form (roughly 40mg of extract 4times daily) by GAIA, Source Naturals, Organic India-since they blend it with micronized pepper for better absorption. If you can afford it, curcumin (in nanoparticle) has great anti-inflammatory properties but if not distilled/extracted properly, you wont absorb the active ingredient without pepper derivative. Glucosamine Sulfate is a great intra-articular anti-inflammatory and can be used for 3 months and discontinued to still have effect lasting 3 more months.....so you can save 6 months a year!! and still have reported improvement in range of motion to an arthritic joint.
Another option if you are between using herbal supplements to control inflammation and prescription use = topical pain relief. Either herbal, over the counter or prescription/compounded medicine. From former to latter, price increases significantly. The benefit is less side effects if used topically. The compounding pharmacist can actually mix NSAIDs/Muscle relaxers together so you avoid taking a pill form and it cuts back on systemic side effects beautifully.
The biggest problems with the NSAIDs I mentioned will be reflux. There are other documented side effects like heart attack from Celebrex, liver congestion, kidney damage, bleeding. Aspirin is an anti-inflammatory that has been used for decades to control inflammation in the arteries. If you take an aspirin a day, wait for 2 hours before doing the NSAID or else the med you use for inflammation will turn off the aspirin heart protective effects.
Most important is to work with a therapist (massage or PT) for moving the muscle tissue, maintain an anti-inflammatory diet during the healing process, do no further harm, get a second opinion if you are not progressing within a month with all the above (or switch to Traditional Chinese Medicine).
