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Non-steroidal Anti-inflammatory Drugs (NSAIDs) for Pain

As a Doctor in the community specializing in pain relief, almost all of my patients have taken a Non-Steroidal Anti-inflammatory Medications (NSAIDs) for pain relief; like ibuprofen, alieve, motrin, etc. I ask every patient, “Have you taken any medication?” It’s either a “Yes”, “No”, or “I don’t like to take anything but I had to do something!”┬áMost of the patients that come into our office are not too keen on taking medications and have to regretfully admit that they had to take something for their pain, unfortunately.

This is a tough place to be. You’re in pain, you don’t have any options, you don’t want to take something, but you have seemingly no other choice. The most concerning thing is that most of the time I ask a very important follow-up question, “Does it help?” Some patients chuckle when they respond and say, “No, it didn’t help at all.” Others say, “Well it just took the edge off.” Very rarely does anyone say that the NSAIDs they’re taking are completely helping their pain. And those that say the NSAIDs help their pain admit that pain relief is only for a temporary period of time until the medication wears off. I would be hard pressed to recall a scenario where a patient of mine took an NSAID for a pain problem and it worked to resolve their issue completely.

So why do we do this? What’s the problem? Are there better options? When is it appropriate to take an NSAID? In this article I hope to answer some of these questions and more as we unfold the physiology, goals, and challenges you may be faced with.

Let me first explain a little about this class of medication as it may answer some of your questions. Non-steroidal anti-inflammatory drugs are exactly that. Non-steroidal means there are no steroids in them, and anti-inflammatory means they get rid of inflammation. That being said, pain can be caused by a lot of different reasons, one of them is inflammation. What that means is if your pain is caused by inflammation, then an anti-inflammatory like ibuprofen will help your pain. If your pain is NOT caused by inflammation, you could take ibuprofen all day long, it’s not going to help relieve your pain at all.

Most patients land somewhere on that spectrum; “I took it, it helped completely”, “I took it, it just took the edge off”, or “I took it, and it didn’t help at all.” This tells me, as the provider, very valuable information. If the NSAID is completely relieving your pain, then your pain is mainly from an inflammatory origin. If it’s just taking the edge off, that tell me there is an inflammatory component but not the whole story. Finally, if there is no relief at all, your condition is not inflammatory. All of these scenarios require much different treatment plans, so it’s important for us to know if you’re taking NSAIDs, and what effect they are having on your pain problem.

All that being said, I would like to explain a bit more so that you can make a clear decision when you decide to take an NSAID or not. Here is what is physiologically happening when inflammation is the source of your pain. At some point there was an injured tissue. When a portion of a tissue is damaged, a certain amount of cells within that tissue die. These dead cells create cellular debris and begin to occupy space in the interstitia. So we have 2 problems at this point. 1) there is cellular debris which needs to be removed 2) there are portions of the tissue that need to heal.

God, in his infinite wisdom, created a process to clean the cellular debris and heal the damaged tissue. It’s called, the inflammatory process. Your body sends out inflammatory cells called macrophages and neutrophils to clean up the cellular debris and prep the site for healing. Once the macrophages and neutrophils have done their job, behind them follow new cells called progenitor cells. These types of cells make new tissue. They are essentially the healing cells.

The major take away here is that inflammation is the bodies natural healing process. If you stop the inflammatory process for any reason you are stopping the natural healing process making it take longer for you to recover. It is your decision to take any medication, however, please be aware that every time you take an anti-inflammatory like ibuprofen for pain relief you are delaying your healing time.

So what can you do? The tissue is injured, it’s swelling up, creating pain, and you are left with no other options but to take an anti-inflammatory right?

Wrong! There are SO many things you can do to manage inflammatory pain levels outside of just stopping the healing process altogether with an ibuprofen. Stay tuned for the next article in this series were we discuss managing inflammatory pain conditions.

About the author

Chiropractor in Exton with a Master's Degree in Applied Clinical Nutrition, Board Certification in Physiotherapy, and Biomechanics Expert. I am very passionate about solving pain problems and look forward to helping solve your pain problem today!