Anti-inflammatories and Healing

[Guest guest]

Here is some research on a topic which may have profound ramifications for

those athletes who routinely use anti-inflammatory drugs for reducing pain,

soreness or stiffness.

<http://www.newscientist.com/news/print.jsp?id=ns99992364>

Painkillers may prevent broken bones healing

Some painkilling drugs may delay or even prevent the healing of fractures,

researchers have warned.

" It's time to tell the public, " says Einhorn, an orthopaedic surgeon

at Boston University Medical Center and also a paid consultant to Merck,

which makes one of the drugs under scrutiny. " It would seem that a prudent

approach is to temporarily avoid the use of these drugs during bone

healing. " ....

The issue may have escaped attention because the older generation of NSAIDS,

such as Ibuprofen and Indomethacin, only appear to delay healing by a few

weeks instead of blocking it. Aspirin is one of the

few NSAIDs that appears to kill pain without this side effect. >

*** I am very glad that you cited this reference, because, for far too long,

the inflammation process has been regarded as an evil that must be avoided at

all costs in injured or sore athletes. Inflammation often is a perfectly

natural healing response of the body to even slight amounts of damage and

infection.

If there were no inflammation response, our bodies would not heal. It is

only when the level of inflammation becomes excessive (how does one assess

this objectively?) in certain processes that it needs to be decreased.

Certainly, in the case of most non-traumatic, less serious musculoskeletal

injuries, the casual or routine use of anti-inflammatories would appear to be

entirely unnecessary or even detrimental to the healing process. The

biochemicals (or eicosanoids), such as prostaglandins and leukotrienes, are

released in the body in an attempt to facilitate healing, not necessarily to

worsen your condition (although some research is now suggesting that large

amounts of prostaglandins may induce tumour formation).

NON STEROIDAL ANTI-INFLAMMATORIES

NSAIDs (Nonsteroidal anti-inflammatory drugs) are a group of drugs commonly

used to treat some musculoskeletal conditions like arthritis because of their

analgesic (pain-killing), anti-inflammatory, and antipyretic (fever-reducing)

properties.

The inflammatory stimulus (such as injury or infection) induce

" phospholipids " (certain fatty acids) in the cell membrane to release arachi

donic acid which, in turn breaks down to prostaglandins, thromboxanes and

leukotrienes with the assistance of phospholipase A2. The process now

proceeds along two synthetic pathways, the cyclooxygenase (COX-1 and COX-2

forms) and lipoxygenase pathways. [Note that all biochemicals ending in the

suffix " -ase " refer to enzymes, which facilitate chemical processes, but do

not chemically change themselves]. The prostaglandins (there are quite a few

of these) in particular play a key role in producing the inflammatory

response.

Now, the NSAIDs work by inhibiting of the enzyme cyclooxygenase, which breaks

arachidonic acid down to prostaglandins, thromboxanes and leukotrienes. In

other words, NSAIDs interfere with prostaglandin production by inhibiting

cyclooxygenase. The newer NSAIDs (like Vioxx and Celebrex) are aimed at

reducing the production of the COX-2 enzyme which is regarded as the one

being most involved in the inflammation process, while the COX-1 enzyme is

left unaffected because it is important for vital processes in the body (such

as platelet aggregation, kidney function and maintenance of the gastric

lining). These drugs have attracted both support and condemnation, so the

" jury is out " at the moment regarding their routine use.

Prostaglandins, which are inhibited by NSAIDs, function in the body to

protect the stomach lining, promote clotting of the blood, regulate salt and

fluid balance, and maintain blood flow to the kidneys when kidney function is

reduced. By decreasing the amount of prostaglandins, NSAIDs can cause

stomach irritation, gastric bleeding, impaired chondrocyte (cartilage)

function, prolonged tissue healing, fluid retention, and impaired kidney

function. Some NSAIDs, particularly indomethacin, can interfere with the

action of drugs used to control hypertension and cardiac problems in

patients who take beta-blockers, angiotensin-converting enzyme (ACE)

inhibitors, or diuretics.

Commonly used NSAIDs include: Ibuprofen, Indomethacin, Feldene, Naprosyn,

Voltaren, Dolobid, Nalfon, Ansaid, Motrin, Indocin, Orudis, Meclomen,

Clinoril, Tolectin, Daypro and Relafen.

It is interesting to note that the vasoconstrictive and muscle constricting

activities of prostaglandins contribute to the normal sloughing of the

endometrial lining during menstruation, so that NSAIDs may not be advisable

at certain times for premenopausal women. In addition, NSAIDs can inhibit

blood clotting, which is not desirable during menstruation. At the same

time it should be noted that excessive production of prostaglandins in the

uterine endometrium is involved in the pain, cramping, vomiting, and diarrhea

of dysmenorrheoa.

This website gives more information on the COX anti-inflammatories:

<http://www.hopkins-arthritis.som.jhmi.edu/osteo/osteo_new_treat.html#ref1>

STEROIDAL ANTI-INFLAMMATORIES

Since we have been focusing on the Non-steroidal anti-inflammatories, it is

fair and logical to ask something about Steroidal anti-inflammatories. The

best known of these are " cortisone " and " hydrocortisone " These

anti-inflammatory corticosteroids inhibit the activation of phospholipase A2

by causing the synthesis of an

inhibitory protein called lipocortin. It is lipocortin that inhibits the

activity of phospholipases and therefore

limits prostaglandin production.

Oral steroids are usually a form of prednisone and include prednisone,

prednisolone, and methylprednisolone. Oral steroids are used to treat a

variety of diseases and to help prevent transplant rejection. Diseases

treated with oral steroids include asthma, systemic lupus erythematosus

(SLE), and many other inflammation-based diseases. Topical Steroids are

anti-inflammatory drugs that are applied directly to a specific area of the

skin to treat many inflammatory skin diseases, and are available in a variety

of forms, such as lotions, creams, ointments, nasal/mouth sprays (for

asthma), or solutions.

----------------

Dr Mel C Siff

Denver, USA

http://groups.yahoo.com/group/Supertraining/