Over the counter (OTC) medication use is common place among athletes and weekend warriors. Orthopedic injuries are often treated with anti-inflammatories and physical therapy. Understanding their use, benefits, and side effects can attribute to more effective and safer use.
Before we begin, I would like to provide a disclaimer. As a certified athletic trainer, I do not have the ability to prescribe medication nor dispense OTC medication. My ultimate recommendation is to consult with your physician and/or pharmacist for medication advise. These professionals have much more thorough training with regards to medication. They can help with dosage and drug interactions. Every substance ingested may interact. This isn't limited to just medication. Supplements, alcohol, certain foods, and other medications may have adverse effects of one another. This is why it is vital to discuss interactions with the appropriate professionals.
With that being said, the first thing to know is the naming and clarification of anti-inflammatories. Most familiar anti-inflammatories are classified as Non-steroidal Anti-inflammatory Drugs (NSAID's). NSAID's can be classified as OTC, meaning they can be purchased without prescription. Stronger NSAID's require a prescription to purchase. Drugs also have different naming characteristics as well. There is typically a brand name as well as the chemical name. For example, Advil is the brand name with the active ingredient ibuprofen. You may also see generic medication with different brand names but the same active ingredient. Prescription drugs follow the same rules. A common NSAID prescribed by physicians that I have worked with is Voltaren with the active ingredient Diclofenac Sodium. It's important to note the active ingredient in medications to avoid overdose. For example, taking Advil and Motrin at the same time because both help sore muscles is ill advised because they are the same active ingredient, ibuprofen. Combined medications such as Advil Cold and Sinus has ibuprofen in addition to the active ingredients for sinus decongestion and cough suppression. Taking ibuprofen in addition to Advil Cold and Sinus could lead to an overdose. Again, consult with an appropriate professional if you have questions.
The process by which anti-inflammatories work involves suppressing chemical reactions in the body which produce inflammation. NSAID's act as a pain killer because of the decrease in pain associated with the decrease in inflammation. Another byproduct is the suppression of the chemical reactions that produce the lining of the stomach. This is why use of anti-inflammatories can cause issues with the stomach and gastrointestinal (GI) tract. Chronic use of NSAID's may lead to GI issues as well. Most anti-inflammatories are prescribed to be taken with food for this reason.
Another interesting note is the idea of inflammation being a bad thing. Inflammation is natural in the healing process and taking medication may not always be the best idea, at least right away. One of the physicians I used to work with would usually wait 24-72 hours after an acute injury to start anti-inflammatories to allow for the initial onset of inflammation and healing process. Chronic inflammation, on the other hand, can be a greater issue that anti-inflammatories may help to relieve. It goes back to balance. Inflammation is necessary for healing but too much may be detrimental to health. There are dietary changes that can be made to adjust for chronic inflammation as well as blood test that can be done to measure markers of inflammation.
NSAID's may be beneficial in controlling inflammation as the biproduct of physical stress, exercise, and injury. My concern is finding a way for the athlete to feel better without reliance on NSAID's. Recovery and soft tissue treatments as well as preemptive rehabilitation may be able to keep inflammation in check without the need for drugs. Often I hear players take NSAID's as a part of their routine. I believe this is more of a psychological dependency than a physiological necessity.
If anti-inflammatories are needed, it's best to use them as directed. Anti-inflammatories are prescribed as a dose usually for 7-28 days or longer. Taking anti-inflammatories in this way allows for a longer lasting effect and OTC anti-inflammatories may be used the same way. In other words, it may be more beneficial to take a week long dose of ibuprofen vs. a single dose. Again, discuss this with your physician.
NSAID's are typically in pill form. However, one active ingredient, Diclofenac, has been made into a gel as well. For a long time this was sold as a prescription under the name Voltaren Gel. Recently it has been released to sell over the counter and is available in generic form as well. Voltaren gel works well as a topical anti-inflammatory. The skin absorbs the active ingredient when applied. For this reason, it's important not to use Voltaren gel and take NSAID's at the same time without...you guessed it, consulting your physician.
Another class of anti-inflammatories are called steroidal anti-inflammatories. Steroids have two classifications, anabolic and catabolic. Anabolic steroids are associated with muscle gain. Anabolic means to build up. Catabolic steroids break down tissue. Catabolic steroids are often used in orthopedic injections to spot treat specific areas of inflammation. These are your traditional cortisone shots. Catabolic steroids are also available in pill form by the name methylprednisolone or Medrol. If catabolic steroids break down tissue, why would physicians use them? One of the best analogies that I have been taught is the idea of a biting the inside of your cheek. When you bite the tissue in your cheek it tends to swell and continue to get bitten. If the tissue could be mildly broken down healing may be promoted because of the lack of reinjury. The use of catabolic steroids allows for the break down of inflamed tissue in a little more aggressive manner. With that being said, overuse of catabolic steroids can lead to further degradation of tissues and subsequent injuries. This is one of the reasons catabolic steroids are a prescription medication.
On an interesting note, hydrocortisone cream is an OTC catabolic steroid medication used for relief of itchy skin. The medication literally breaks down the skin. However, the active ingredient is in such a small proportion (usually 1%) making it safe to use.
There is one other common OTC pain medication that gets lumped in with NSAID's but doesn't actually qualify as an NSAID since it is not an Anti-inflammatory. The medication is acetaminophen otherwise known as Tylenol. Acetaminophen works to numb the sensation of pain but does not work as an Anti-inflammatory. Just like the addition of ibuprofen to Cold medicine, acetaminophen is added to cold medication as well. It's important not to double dose on acetaminophen since it can be much more damaging to the the body. One common medication in baseball clubhouses is Excedrin or Pain-Off. This is a combination of aspirin, acetaminophen, and caffeine. It's intended to be used for migraine treatment. However, the anti-inflammatory aspirin, pain killing acetaminophen, and stimulate caffeine make it appealing to athletes to use far more frequently than is recommended or safe. This is a perfect example of how knowing basic information about medication can help to make better decisions.
To recap, anti-inflammatory medications are either non-steroidal (NSAID's) or steroidal (catabolic). Their names can be misleading as the active ingredient and brand name may be different for the same medication. Mixing or overuse of medication can be detrimental to short and long term health. Finally, if in doubt, consult your physician or pharmacist. That's all for now...from the training room.
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