Why anti inflammatory slow down healing

Almost everyone needs at least seven hours of sleep a night to function at their best and stay healthy, and most adults need eight.

Adolescents need at least nine hours. In the s the average American slept more than eight hours per night. Now, however, the average American sleeps only 6. This decreased sleep worsens health in a number of ways including increased obesity and insulin resistance. However, in the current context, decreased sleep is most noteworthy for causing injuries to occur more easily and take longer to heal.

You should avoid all NSAIDs nonsteroidal anti-inflammatory drugs pain killers, anti-depressants, nerve medicines, and steroids. Check out the reasons why below:. NSAIDs are a class of drugs that all function in similar ways.

Biochemically, they block the synthesis of a class of chemicals called prostaglandins. NSAIDs can relieve pain, decrease inflammation, reduce fever, and act as an anticoagulant blood thinner.

It is well established in scientific literature that NSAIDs slow the healing of broken bones, damaged ligament, and other tissues 1,2,3. If your body is trying to heal damage, NSAIDs can significantly impede progress and lengthen the healing time. For example, the following is a transcript of a video on our website of a patient of mine who had been in severe pain, who I had asked to stop taking her prescription NSAID pills before performing a PRP injection.

I stopped and within three days I started to feel better. The swelling in my knee also started to go down, and I was totally surprised. When you take an NSAID, you feel better because the drug blocks the feelings of pain that your body is producing. However, NSAIDs do not help the problem resolve; they only keep you from feeling pain from it for a while. When the medication wears off, the problem and the pain may be worse than before. Or, if you keep taking the pain pills, eventually the pain will become so severe that you will feel it even while you are still taking the drug.

If you decrease painful activities promptly, most musculoskeletal problems will resolve and the damage will reverse. If you wait until the pain and therefore, the damage is much worse, it may be much more difficult to eliminate the pain. For example, a patient with a partially torn rotator cuff in the shoulder can usually heal if they rest their shoulder. However, taking pain medications or getting cortisone shots will diminish their pain and allow greater use of the arm.

This results in an increased chance they will tear the tendon completely and require surgery — which could potentially have been avoided. NSAIDs can cause stomach and intestinal ulcers. Therefore, at the first sign of stomach upset, they should be discontinued. Continued use can lead to severe and sometimes fatal GI bleeding.

In fact, it was estimated in a New England Journal of Medicine article that 16, deaths occur in the U. Kidney, especially, and also liver failure occur with some regularity, and newer data also shows an increased incidence of heart problems 5. They can additionally be a trigger for asthma attacks. However, they all still can interfere with healing by masking pain and, thus, allowing you to continue to hurt yourself without knowing it. Used in moderation, it is a safe drug, but in high doses it can cause liver damage.

High doses of Acetaminophen leading to toxicity is the second leading cause of liver damage in the United States after alcohol use. Tramadol is a mild narcotic prescription pain reliever. It is a relatively safe drug often combined with acetaminophen.

It can cause drowsiness and constipation, especially in older people. All narcotics are prescription drugs. Commonly prescribed narcotics for musculoskeletal problems include hydrocodone Vicodin , oxycodone Percocet , and codeine Tylenol 3. The most common side effects of narcotics are constipation, altered mental state, and respiratory suppression which can be fatal; and they are highly addictive. They should not routinely be used for moderate musculoskeletal injury.

They may reduce pain but repeated injections accelerate tissue destruction and can cause infections, which can be life threatening. When injected into tendons, they predispose the tendon to rupture. Cymbalta, Elavil, Lexapro, Paxil, and Prozac are examples of anti-depressants which are sometimes used for pain, usually chronic pain. In fact, these medicines are highly addictive, produce unwanted cognitive effects, and are subject to an FDA warning that, in patients under 25 years of age, can increase suicidal ideation.

They also do nothing to treat the underlying problem and can encourage providers to abandon the search for real underlying causes by giving a false sense that something useful is being done for the patient. It is always easier to prescribe a pill for a symptom than to find and treat the problem that underlies the symptom. In my opinion, they should never be used for musculoskeletal problems. There are two commonly used and related drugs in this class: Gaba pentin Neurontin and Pregabalin Lyrica.

If there is a bonafide diagnosed nerve injury, these drugs can be useful. However, they are often prescribed for vague nerve-like symptoms and because they also have a weak pain-killing effect.

However, they can cause drowsiness and a clouded mental state, especially in older people. Voltaren Diclofenac Cream This is a topically applied NSAID, but it is absorbed into the blood and can cause the same serious side effects, healing- inhibition, and symptom-masking as when taken orally; they should be avoided.

These patches work by supplying a local anesthetic to the local area. Again, they do not help healing in any way. These are used for the knee, elbow or elsewhere and apply local pressure to the painful area. They also do not help healing in any way. They do diminish the feeling of pain by flooding the nervous system with signals and, thereby, also encourage increased use of the affected part and increased damage.

What all of these methods — sports creams, pain patches, and braces — have in common is that they do not help the injury heal, but do mask pain symptoms and, thus, encourage damaging overuse. This is the same thing that happens with pain pills. People may well heal in spite of these pain killers, but they will not heal faster. And often they will heal more slowly, sometimes needing more extreme treatment, such as surgery, that could have been avoided had they simply let the body heal itself without interfering with the healing process.

It may surprise you to know that there is no evidence that cooling an injured part helps it heal. Cold has two effects. First, it can decrease blood flow to an area and decrease swelling. But our bodies specifically increase blood flow to an area to bring nutrients and growth factors there to help healing. There is no evidence that it is useful to diminish this natural response to injury. This is all well established in the scientific literature.

However the popularity of these treatments is not about science. The business of selling treatments and medications to hasten healing from musculoskeletal injuries is a gigantic and very profitable industry. Often the treatments and medications are wrapped in complicated medical jargon.

The claims of success are not lies, just carefully worded inferences of success, which are nonetheless misleading. However, patients are looking for something that works and there is no end of sources to satisfy this desire even though none are effective. Below we will explain why such strategies are useless at best and often harmful. Every day cell death occurs. During deep sleep cells are replenished. If you are physically active, you will incur more cell death during the day.

If you do not get sufficient sleep at night you will suffer a net cell loss and eventually injury. Such injuries commonly manifest as tendinitis, muscle strains, or stress fractures.

If you have an acute injury, you have a sudden large loss of healthy tissue to cell death that must be replenished. Almost everyone needs at least 7 hours of sleep a night to function at their best and stay healthy, and most adults need 8 or more.

Adolescents need at least 9 hours. In the s in the United States the average American slept more than 8 hours per night. Now, however, the average American sleeps only 6. This decreased sleep worsens health in a number of ways: including increased obesity and insulin resistance. However in the current context it is most noteworthy for causing injuries to occur more easily and take longer to heal. NSAIDs are a class of drugs that all function in similar ways. Biochemically, they block the synthesis of a class of chemicals called prostaglandins.

NSAIDs can relieve pain, decrease inflammation, reduce fever, and act as an anticoagulant blood thinner. The group includes the common over the counter drugs Ibuprofen also called Advil and Motrin , Naproxen Aleve , and aspirin Excedrin, Bayer, etc.

Additionally, there is a new subclass of these drugs called COX-2 inhibitors. This subclass, which contains the drug celecoxib Celebrex , shares many of the characteristics of general NSAIDs, although they also have some unique characteristics and problems. COX-2 inhibitors do not act as blood thinners and do not reduce fever, but they do reduce pain and decrease inflammation. They also cause less problems in the gastrointestinal GI track but can cause cardiac problems. The newest subclass is a COX-3 drug called Limbrel.

This also relieves pain but does not thin blood. When you take an NSAID, you feel better because the drug blocks the feelings of pain that your body is producing.

When the medication wears off, the pain is worse than before. Or, if you keep taking the pain pills, eventually the pain gets so bad that you can feel it even while you are still taking the drugs. If treated promptly, many pains can be resolved and the damage reversed. If you wait until the pain and therefore the damage is much worse, it may be much more difficult to eliminate the pain. For example, a patient with a partially torn rotator cuff in the shoulder can usually heal if they rest their shoulder.

However taking pain medications or getting cortisone shots will diminish their pain and allow greater use of the arm. This results in an increased chance that they will tear the tendon completely and require surgery — which could and should have been avoided. NSAIDs can cause stomach and intestinal ulcers. Therefore, at the first sign of stomach upset, they should be discontinued. Continued use can lead to severe and sometimes fatal GI bleeding.

While the most serious problems usually occur after symptoms have started, in some cases severe GI bleeds and death have occurred after only short term use. In fact, it was estimated in a New England Journal of Medicine article that 16, deaths occur in the U. This is a frighteningly high number and points out the danger in using these drugs indiscriminately. I have also had patients develop both kidney and liver failure from their use. Multiple studies have shown that using NSAIDs can slow the healing of broken bones, damaged ligament and other tissues.

If you are trying to heal the damage done to a knee, shoulder or other joint, using NSAIDs can significantly lengthen the healing time. Ironically this is because these drugs do exactly what they are advertised to do: i. The problem is that inflammation is part of the necessary steps in healing: a normal, necessary and useful response. In advertisements inflammation is somehow inferred to be a negative thing. Instead, it is a remarkably positive and necessary step in healing.

Blocking the normal inflammation that accompanies injury is blocking part of the normal healing response. Inflammation brings blood to the area to help healing. Platelets and natural growth factors are also brought in. The area swells because healing factors are filling the area. The injured area also produces pain which is critically important to let the injured party know not to use the injured area.

Damage causes broken bones within a joint that never heal because the pain is not felt so it remains untreated. Amputation is a common ultimate outcome. So using NSAIDs to block swelling, inflammation and pain diminishes the nutrient supply to the injured area and allows increased deleterious use of the affected area. In cases where the normal inflammatory mechanism is not working properly, such as in auto immune diseases like rheumatoid arthritis or lupus, interfering with the inflammatory cascade is beneficial.

However in injured patients with normal immune systems, blockade of the inflammatory cascade is only interfering with a step in what is otherwise a remarkably effective self healing mechanism. This mechanism has been honed over millions of years of evolution to heal us with maximum speed and efficacy. Inhibition of fracture healing. J Bone Joint Surg Br. Elderly men with a history of distal radius fracture have significantly lower calcaneal bone density and free androgen index than age-matched controls.

Aging Male. J Trauma Acute Care Surg. Non-steroidal anti-inflammatory drugs NSAIDs for axial spondyloarthritis ankylosing spondylitis and non-radiographic axial spondyloarthritis Cochrane Database Syst Rev. Cyclooxygenase 2 function is essential for bone fracture healing. J Bone Miner Res. Aspenberg P. Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs. J Orthop Res. Cyclooxygenase-2 inhibitors in human skeletal fracture healing.

Effects of a cyclooxygenase 2 inhibitor on fracture healing in a rat model. Nonsteroidal anti-inflammatory drug-induced fracture nonunion: an inhibition of angiogenesis? J Bone Joint Surg Am. The effects of COX-2 inhibitor during osteogenic differentiation of bone marrow-derived human mesenchymal stem cells. Stem Cells Dev. Anti-inflammatory drugs suppress proliferation and induce apoptosis through altering expressions of cell cycle regulators and pro-apoptotic factors in cultured human osteoblasts.

Celecoxib inhibits osteoblast maturation by suppressing the expression of Wnt target genes. J Pharmacol Sci. The multifactorial aetiology of fracture nonunion and the importance of searching for latent infection. Bone Joint Res. Heterotopic ossification prophylaxis with indomethacin increases the risk of long-bone nonunion. Nonunion of the femoral diaphysis: the influence of reaming and non-steroidal anti-inflammatory drugs.

Indomethacin prophylaxis for heterotopic ossification after acetabular fracture surgery increases the risk for nonunion of the posterior wall.

J Orthop Trauma. Non-steroidal anti-inflammatory drugs and bone-healing: a systematic review of research quality. JBJS Rev. Decreased bone density in men on methadone maintenance therapy. Postoperative opioid administration inhibits bone healing in an animal model. Clin Orthop Relat Res. Janas A, Folwarczna J. Opioid receptor agonist may favorable bone mechanical prosperities in rats with estrogen efficiency induced osteoporosis.

Naunyn Schmiedebergs Arch Pharmacol. Inhibition of cyclooxygenase-2 down-regulates osteoclast and osteoblast differentiation and favours adipocyte formation in vitro. Eur J Pharmacol. J Pharm Pharmacol. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process. Basic Clin Pharmacol Toxicol. Fransen M, Neal B. Non-steroidal anti-inflammatory drugs for preventing heterotopic bone formation after hip arthroplasty. Cochrane Database Syst Rev. Similar effects of rofecoxib and indomethacin on the incidence of heterotopic ossification after hip arthroplasty.

Acta Orthop. Heterotopic bone formation prevented by diclofenac: prospective study of hip arthroplasties. Acta Orthop Scand. No difference between two doses of diclofenac in prophylaxis of heterotopic ossifications after total hip arthroplasty. Joint inflammation and early degeneration induced by high force reaching are attenuated by ibuprofen in an animal model of work-related musculoskeletal disorder.

J Biomed Biotechnol. Bone loss from high repetitive high force loading is prevented by ibuprofen treatment. J Musculoskelet Neuronal Interact. Angiogenic factors in bone local environment.

Cytokine Growth Factor Rev. J Periodontol. Hu K, Olsen BR. The roles of vascular endothelial growth factor in bone repair and regeneration. Vascular endothelial growth factor control mechanisms in skeletal growth and repair. Dev Dyn. Anti-inflammatory treatment increases angiogenesis during early fracture healing. Arch Orthop Trauma Surg.