Should you take ibuprofen for an injury?

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Toxicology is definitely not something I know much about. I had no idea how deep of a topic this was before I started researching it. So keep in mind I could be misinterpretating some things, but I’m going to try and give as clear of a picture as I can so you can avoid the mind numbing research I had to do to try and understand all this. The types of drugs I’m going to be talking about are the most common ones people tell me they take, Advil and Motrin (which are made of the same drug), and Aleve. These 3 drugs are all considered part of the NSAID class of drugs, anti-inflammatories, which is the class I’ll be referring to the most.

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Let’s set the mood: You sprain your ankle. Inevitably, at least one person around you states with authority, “Put some ice on it and take some ibuprofen!”

We’ve already seen whether or not icing an injury matters, but what about taking ibuprofen or other drugs? I don’t think any of us have any doubt they help the pain go away, but is that helping the ankle’s recovery? (Or whatever the injury is.)

The first paper I found about this question was:

–The Role of Nonsteroidal Anti-Inflammatory Drugs in the Treatment of Acute Soft Tissue Injuries.

Similar to what I talked about in my post on ice, this paper mentions how an inflammatory response to an injury is necessary in order for healing to occur. Furthermore, the body actually already has mechanisms in place to have only so much swelling occur at the site of injury. Once it senses an excessive amount of inflammation is occurring it restricts any more. Basically evolution has already taken care of the job of healing an injury. That doesn’t mean we can’t improve upon it though.

The paper goes on to cite a crapload of studies on various NSAIDs and their role in soft-tissue injuries.

Note: NSAIDS are a class of anti-inflammatory drugs. Ibuprofen and naproxen are the most common over the table ones that people buy. Advil and Motrin are made from ibuprofen while Aleve is made of naproxen. Notice that acetaminopen, aka Tylenol, is NOT part of this class.

The conclusion of the review is pretty clear:

“There is little evidence to support the claim that NSAIDs hasten the return of injured athlete’s competition.”

Ok, so based on this review it doesn’t appear that taking Advil or Aleve is doing a whole lot to help improve recovery. At least it’s still helping improve the pain of that ankle sprain, right?

Well, yeah, there is no doubt the drugs help decrease the amount of pain, but what this paper also talks about is not only do the drugs not improve recovery time or the functional outcome of the injury, some of them have been found to delay recovery. Obviously one thing you don’t want to do is make your ankle sprain last longer. Unfortunately though, there haven’t been many studies on this with humans.

Also worth mentioning is while the majority of the studies cited found either no impact or a negative impact, there were a small minority that found a benefit. If you look at these studies closely enough you find a lot of them find a benefit…for about a week or two. The negative impact is found down the line, a ~month after injury. That is, some studies found that achieving a short-term benefit was at longterm expense. And for the studies only finding a positive impact? They weren’t done for a long enough timeline to know if a negative impact would have also been found. Finally, some studies concluded an NSAID was effective if it resulted in a “relief of symptoms.” There are a lot of modalities that can give relief of symptoms (have a few beers) but that does not mean it is hastening recovery or the functional outcome.

Naproxen and ibuprofen are two that are basically found to not have any effect. They help pain, they don’t help improve recovery, but they don’t seem to delay recovery either. The NSAIDs found to hinder recovery are those not typically found over the counter. If you’re really interested in all of the specific drugs looked at, check out the paper.

So far it seems Motrin and Aleve are akin to icing an injury: They make you feel a bit better but don’t do much beyond that. What I haven’t mentioned is the above study dealt only with soft-tissue injury, which is kind of vague. After looking around some more I found other papers that have actually broken down NSAIDs and their influence specifically on bone, tendon, and ligament injuries.

–The use of therapeutic medications for soft-tissue injuries in sports medicine

and

–Do NSAIDs impair healing of musculoskeletal injuries?

do a great job of breaking this down.

Some quotes:

“The use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat most muscle, ligament and tendon injuries should be reassessed. They have, at best, a mild effect on relieving symptoms and are potentially deleterious to tissue healing.“

“Anti-inflammatory treatment for 6 weeks and/or subacromial corticosteroid and local anaesthetic injections are among the best therapeutic options for giving pain relief. These will generally provide analgesia, but may have potentially deleterious effects on tendon healing. .. Exercise rehabilitation is the cornerstone of managing tendinopathies to regain function “  

-> For more about this check out issues with cortisone shots.

The biggest cause for alarm is while the jury is still not conclusive on muscle, ligament or tendon injuries, it seems to be pretty damn apparent NSAIDs negatively affect healing from bone fractures. While in other instances it seemed to not have a negative impact, when it comes to bone healing ibuprofen definitely seems to have a negative impact to where it is consistently NOT recommended to be taken after breaking a bone. I didn’t come across much data on naproxen though.

But wait, didn’t I write a whole post about how taking ibuprofen after exercise was beneficial for increasing bone density? Well,

1) Healing from a fracture and a workout aren’t quite the same

2) The dosage and duration of treatment weren’t the same. In the study done on exercisers ibuprofen was only taken after exercise 3 times a week. In contrast most studies involving injuries it was taken everyday, multiple times per day, for at least a week.

Next issue (I told you this was mindnumbing): If you look around enough you’ll actually find some studies, very, very good studies, stating NSAIDs taken before and after surgery have a profound impact on the long-term outcome of the surgery, in favor of the drugs.

What the hell? We have a crapload of studies saying there are barely (if any) benefits to taking NSAIDs after injury, which surgery resembles, yet we have a couple EXTREMELY good studies saying they are good for recovering from surgery.

A couple of studies by the same author, funded by Pfizer, a company who makes the drugs used in the couple of studies, all by the same author…who is now in jail for writing research papers he never conducted.

If you’re lost this dude named Scott Reuben got a bunch of money from Pfizer to conduct research trying to find benefits of their drugs for people having surgery. This was due to the fact that sales had been plummeting as all this research was coming out showing not only did their drugs not work very well, but they had side effects, such as increasing the risk of a heart attack. Ah, that beloved money trail.

So we can forget worrying about those studies. Even though they had me dumbfounded for a good hour til I googled Scott Reuben. Oh, and as new, apparently non-corrupt studies come out, they are finding the opposite of what Reuben “found.”

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At the end of the day it doesn’t appear to be a good choice to take Advil, Motrin, Aleve, or whatever NSAID (remember: anti-inflammatory drugs) to help improve healing an injury. They don’t appear to be terrible choices, but if their only real benefit is pain relief and all these negative things have been found, why not just use something else that hasn’t been found to have the same potential side-effects?

As I’ve talked about, ice isn’t a bad choice. In terms of drugs though, acetaminophen, Tylenol, appears to be a nice choice. It isn’t of the NSAID class but plenty of the above studies cite how it is just as effective for pain relief. One quote:

“Paracetamol (another name for Tylenol) is an analgesic with a centrally mediated mechanism of action.With comparable efficacy to NSAIDs for pain in soft- tissue injury (E2),12 and being both opioid-sparing and NSAID- sparing, it can be used in combination analgesia. It also has a low cost, low side-effect profile, and no risk of local soft-tissue injury. It is often the analgesic of choice for soft-tissue injury. “

I haven’t really talked about the potential side-effects of NSAIDs because I don’t really know many people who have any issues with them, but they are apparently much more likely to cause people stomach issues than e.g. Tylenol. I actually had client a while back who wore away the lining of her stomach to such a degree she basically couldn’t physically exert herself without serious risk of making herself vomit. She said this was due to taking an excessive amount of ibuprofen during her teenage years. Seems to be quite rare, yet worth mentioning.

Alright, whew, so finally if you are going to take an NSAID drug after an injury I’d probably only do it once, akin to the study on people who took ibuprofen once after exercising. It just doesn’t seem to be worth the potential risks to take more than that, especially when there are other options. Then, if pain relief is still really desired, I would switch to other means. Tylenol and maybe ice to be specific. This would be to decrease the amount of pain you are experiencing. It is not likely to improve your recovery time.