This was in yesterday’s NY Times. This is not the study that came out a week or so ago that stated that ibuprofen can impede muscle regeneration after a workout, though that study is referred to here.
http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/?ref=health
Supports from a different angle the common knowledge. Ask an experienced marathoner (at least the ones I know, who are MDs): Ibuprofen is for sore joints, not overused muscles.
I use Diclofenac.
Hey PA, have you seen any of the studies regarding heart attacks and diclofenac?
http://www.nhs.uk/news/2011/09September/Pages/nsaid-painkiller-heart-risk-analysed.aspx
No hadn't seen that.
Mine is a prescription and I have taken maybe 30 doses over the past 4 years, no family history of cardiac disease, and no other risk factors = so I'm not real concerned.
The stuff works like magic though for sore/stiff joints or overuse pain.
I use good old aspirin for my chrondomalacia knees after rides when I feel them. Works wonders, both in the short term and long term. (1-2 325 mg) Also 81 mg/might at the advice of my doctor for my ticker. I do understand that there is an adverse correlation with heart attacks. (Adverse, as in more aspirin, fewer heart attacks. A correlation I am willing to accept.)
Muscles? Massage occasionally.
Ben
Why are healthy people medicating, period? (I'm shooting myself in the foot, I guess, given whom my salary comes from.) There being no such animal as a drug that doesn't come with consequences, the question for health care professionals and researchers is always "Since this medication, no matter what it is, will cause biological complications of some kind later on ('downstream,' as we often bucolically euphemise such dangers), how does the immediate benefit justify the eventual cost?"
This is an easy economics to contemplate in the case of drugs that literally forestall death, such as many cancer drugs that are known to cause or accelerate additional cancers unrelated to the primary tumor: if Die-Now-or-Die-Later is the grim set of options, we scarcely blink to chose "Die Later."
In the case of drugs that don't do much except block routine pain or arrest mildly unpleasant symptoms that could be just as expediently treated with changes in diet or living habits, that economics becomes murky. If inflammation, say, threatens an organ or organ system in a serious way, then fine -- I get it that ibuprofen or even steroids may be regarded as a useful treatment whose offset in risk is justifiable. But the idea that ibuprofen -- let alone something like cortisone -- doesn't manipulate cell biology to a significant extent is just completely foolish. In the case of OTC analgesics and anti-inflammatories and the like, the consequences are distant ones generally, and agreeable therefore to various forms of rationalization. You're delusional, though, if you think for one second that you can use something like that habitually, and not reckon with the inevitable payback. Even a seemingly innocuous medication cannot work at all except by interfering with a delicate systemic equilibrium, established by millennia of natural selection.
The truth is, if you are a competitive long distance runner, and I am not talking about the guy that runs 15 mins at lunch, then you pretty much live with pain in your life every day. Running at a high level is pretty tough on the body. Not surprised at all that so many top-level marathoners use Ibuprofen before and after a race.
Elle, I have had my lifelong knee condition for 35 years. I could stay drug free and limit my riding, especially in cold weather, to preserve those knees. Not listening to them and breaking the rules I learned when I was diagnosed in 1978 will quickly take me to knee replacement.
Aspirin, Motrine and Ibuprofen have all been suggested or prescribed for my knees by doctors. All have healing effects that go long after the pain relief has worn off. I enjoy the pain relief, but I value my knees more.
I could change my living habits. For my knees, better stretching and quad exercises would be good. Better discipline on the bike also. Not riding would be better. I should do the former. I am not willing to give up the laters.
Ben
OK, 79, it sounds as if you're making an astute judgment in full awareness of the probable downside. Have at it. I should mention, though, that your doctor, like an any physician operating at the clinical/patient "interface," knows next to nothing about the hardcore pharmacological science of the medications he or she is prescribing and recommending. They don't have that kind of time. Most of that expertise, such as it is, depends on a guileless public and in any case actually originates in pharmaceutical salespeople exhorting their marks to push this or that, and subtly (or not so subtly) exerting coercive pressures in the form of junkets and soft-bribary. Nowadays, however, it's possible even for the lay public to be very informed, at least to the point of healthy skepticism.
I'm staying as far away from any pills, human or in tablet form, as I possibly can.
For the tablet form I make an exception for accute hangovers now that I have limited time to let the after-effects subside. That's become few and far between tho.
As a person who suffers GERD with Barrett's I tend to avoid Ibuprofen and all pain meds, prescription or OTC, like the Plague! Only use them when I am at my limits. Already have enough troubles with a less than stellar esophageal sphincter and don't need additional chemically induced leakage.
This is also why I won't ride for at least 45 minutes after eating breakfast and prefer to have a good hour before even starting to warm-up.
"Why are healthy people medicating, period? "
Fair question, but this has been going around for a while:
The 2000 year old wonder-drug
NYT, 12/12/12
http://www.nytimes.com/2012/12/12/opinion/the-2000-year-old-wonder-drug.html?_r=0
I've stayed away from aspirin and any other kind of blood-thinner, per doctor's advice, since my head-injury crash in '08. I may have to try some ibuprofen soon, though, because I just weaked the troublesome sciatic in my right hip. That was Sunday, and when I tried a ride on Monday, I had to cut it short and was basically riding one-legged at 4-5 mph below my normal pace. Same today, though the pain was worse, and I headed home after less than two miles. I've managed to keep my sciatica at bay for years with daily abs exercises and careful stretching, but I have to be careful of awkward lifting and carrying heavy things any distance.
Ibuprofen also interferes with the cardio-protective action of aspirin, if taken within a couple of hours of the aspirin.
I agree with longslowdistance: ibuprofen for sore joints. In addition, I occasionally use aspirin or Excedrin (aspirin/acetaminophen/caffeine) for head-ache and naproxen for soft-tissue aches, like a sprained ankle.
Ben- Motrin and Advil are two brands of ibuprofen.
Of the common OTC painkillers, only acetaminophen (eg, Tylenol) is not an NSAID. Aspirin, ibuprofen, ketoprofen, and naproxen are all non-steroidal anti-inflammatory drugs. As such, they may contribute to the intestinal leakage described in the NY Times article. They definitely are linked to greater risk of GERD and stomach bleeding.
ElleSeven- Do you work for Pharma? I used to work for Wyeth before Pfizer bought us and Pfired most everybody.
I think the chronic pain of elite high endurance athletes is very different from the delayed onset muscle soreness that most recreational athletes experience when they over-do it once in awhile.
Some of the thinking behind delayed onset muscle soreness has changed over the years. 20 years ago the thought was it represented tissue leak and micro tissue damage mostly at the cell membrane level. The thought was that damage was what caused the body to "re-build" and "super compensate" and that treating the pain and damage was probably not a good thing because you might limit the training effect. Then people found that likely you could get "rebuilding" without all the damage. The thinking became why not prevent the damage if we can still get rebuilding. Anti-inflammatories became popular. That was followed by cold baths and compression stockings. Now the pendulum is swinging back away from anti-inflammatories, cold baths, and at least for post activity recovery is starting to swing away from compression stockings.
If you over do it and feel sore then a bit of ibuprofen to ease the pain is effective and is not going to cause you any problems. Prophylactically taking ibuprofen before and after every workout thinking it is having some benefit is probably not a great idea. Having said that, most of the studies saying it is a bad thing are not the greatest studies ever done. But, it still seems prudent to think that taking medications as a regular part of a recreational activity is not a great idea.
Smokey, um, maybe not, as our fellow 'mite Plan-B would put it. (Generally prominent amidst the non-disclosure red ink that one deals with in this industry are interdictions against blogging, public on-line badinage, unapproved media interviewing, and so on. The clear import, veiled as protection of intellectual property, is concern about whistle-blowing.)
Anyway, I need to make something clear. I am not against medication. I'm nervous, being in an industry in which major problems with drugs and regimes in development and on the market are routinely "papered over," about the relatively little examined preoccupation in our lives these days with medicating where no threatening or even inconveniencing disease exists.
Most often nowadays, this comes in the form of arresting symptoms. If the symptom itself will kill or maim the patient, that's one thing. If the symptom is an inconvenience, that's something else. And the difficulty with "something else" is that neutralizing minor localized symptoms often places the body under greater pressure to surmount the invading pathogen with biologic workarounds that are potentially devastating. For someone like me who deals in etiological research it's part and parcel of what we do to understand many kinds of symptoms as, in fact, normal health-restorative responses to infection and injury. Inflammation is a perfect example: as a component of so-called "innate immune response," inflammation is a creation of your own biology to deal with a threat to its stability. It's not something that the pathogen or the traumatic event is doing. It's what your own body is doing to respond to that invasion or event.
Any time you treat even minor inflammation with an exogenous therapy (ibuprofen or aspirin, for example) you are by definition interfering with, and possibly stopping altogether, the organism's built-in defense against or compensation for whatever happens to be disturbing it. But healthy organisms don't just back off when their immediate, localized assault is interrupted; they go postal, as it were, driving system-wide countermeasures that end up being, in the long term, more dangerous than the original intrusion.
I wish I could feel more sanguine about modest treatments and therapies -- an antihistamine here, a prostaglandin-inhibitor there -- but I can't and don't. Because I see every day what happens when you press this kind of unbalancing strategy onto the self-correcting equilibria of homeostatic systems. Meanwhile, for those interested, I would suggest two books that will illuminate what sort of suspicion should be brought to bear. Both are available through Amazon and through library distribution catalogues like Link+.
http://www.amazon.com/Testing-Treatments-Imogen-Evans/dp/1905177356 ["Testing Treatments," Imogen Evans]
http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dstripbooks&field-keywords=big+pharma ["Big Pharma," Ben Goldacre]
Fine print, not "red ink." This damned language!
ElleSeven- I am quite aware of the legal interdictions against biting the hand that feeds you. I don't see that you've crossed the line, assuming you have the standard gag rules of the industry.
I generally don't like using analogies to explain a point, but sometimes it helps. In my experience, there is no such thing as a simple plumbing job. In our old house in Monroeville, PA many years ago, when I cleared a jam in the archaic garbage disposal, it cascaded to a leak down the line. Bodies are like that too. General chemical therapy has unintended effects. By the way, when you speak of equilibrium, I think you mean steady-state, since energy is expended to maintain the balance. Also, the Goldacre book is "Bad Pharma", not "Big Pharma", which indicates a bit of a slant.
Argh, my "Bad ... Pharma." Sorry again. I'm not the apologetic type; to have cravenly asked for forgiveness twice in one day — that's beyond the pail. I mean, pale.
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