Monday, 10 October 2016, 6:00 AM
By Dr. Neil Averis

Anti-infammatories are very commonly used in all sports. From over the counter drugs like aspirin, ibuprofen, naproxen and now diclofenac, to stronger prescription only versions of the above and others. All these anti-inflammatories are in wide use for pain relief especially of musculoskeletal origin.

Anti-inflammatories work, as the name suggests, by interfering with the inflammatory process. This is the body’s universal reaction to infection or trauma and causes increased blood flow, white cells aggregation to fight infection and to trigger healing and repair processes, to create new scar or bone.

If this is a natural process how can turning it off be good? And that is the difficulty with inflammation. Sometimes the healing process goes on too long and can create too much scar or over healing. However, anti-inflammatories may allow an infection to spread and may also slow proper healing especially of bone. They certainly reduce pain but again maybe this pain is what is needed to tell the athlete to rest the injury. 

Anti-inflammatories are best used with caution, and avoided completely if there is any risk of infection. Arguably they should only be used when the inflammatory process has gone on too long or has been
over reactive given the severity of the injury. 

Simple painkillers like Paracetamol and Codeine work differently; they act on receptors in your head to diminish the appreciation of pain and do not interfere with inflammation at the site of the injury. They may be a better choice for pain relief of the recent injury.

The reality is, however, that antiinflammatories are widely used in the sporting context, often in the less than ideal situation of allowing an individual to compete.

Anti-inflammatories are not without side effects; principally they cause gastric irritation and even stomach ulceration in the susceptible. They can also contribute to kidney failure; an issue if dehydration occurs in long hot events. In some they may trigger asthma. Care must be taken with dosage, overdosing will only give more side effects, no extra benefits. Care must be taken to always take anti-inflammatories with food and to be well hydrated especially if taken during an event.

Most athletes do come to race day carrying some niggles or concern about possible injury and there is no doubt antiinflammatories are effective in suppressing pain and re-aggravation. Some nerve antiinflammatories are less likely to cause stomach irritation and these are known as Cox – 2 anti-inflammatories. Vioxx was initially introduced before being withdrawn, Celebrex being the most popular Cox – 2 available now.

These are much less likely to cause stomach upset but are more expensive and not funded on prescription. Early concerns that they may carry additional cardiac risk appear to have been laid to rest and are certainly a better option for the athlete that can’t tolerate the normal anti-inflammatories.

Topical forms of anti-inflammatories such as gels and creams probably don’t really work unless the site of inflammation to be treated is very near the skin surface. 

Hopefully I haven’t put you off antiinflammatories completely. They are very effective, most athletes, especially if over 40, are likely to feel better taking them and they also prevent D.O.M.S (delayed onset muscle soreness).

If you have an injury you are best to get a good opinion on the nature and severity of the injury so that anti-inflammatories can be used in an appropriate and timely fashion if needed. Avoid taking them routinely just to mask symptoms so you can keep trucking.

Remember the value of R.I.C.E (rest, ice, compression and elevation) in the initial treatment of injury.

Originally published in New Zealand Multisport and Triathlete Issue 75, May 2010.


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