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I know that NSAIDs can worsen the healing process of certain tissues in body such as bones. It is the irony of the history that they are now so popular (they do have side-effects). I think this is psychologically quite hard topic in itself because a large portion of units such as recruits here damage themselves (the reason not clear and the connection to NSAIDs hard to make).

Personally, I use perhaps once in year NSAIDs, so very rarely -- and when I do, I do not trust my feelings at all (and I do try to avoid all kind of activity when I use them). I do have close-experience with people who have got strokes etc after not healing themselves properly before intensive trainings.

What are the adverse personal effects of using NSAIDs during training?

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I'm a little unclear on what question is being asked. –  Dave Liepmann Dec 30 '11 at 14:45
    
@hhh The Stack Exchange Q&A is not meant for discussions. –  Matt Chan Dec 30 '11 at 15:12
    
Just to be clear, you are talking specifically about endurance training (e.g. long runs), right? –  Greg Dec 30 '11 at 16:25
    
@Greg: yes, not generally. I am meaning NSAIDs over long runs etc i.e. endurance. It is totally different issue as over short distances... –  user2598 Dec 30 '11 at 18:30

4 Answers 4

Advil (aka Ibuprofin) has been known to affect kidney function, (admittedly in high dosages) which can be contraindicated when you are dehydrated. That is when you are most interested in properly functioning kidneys.

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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) have pros and cons. Using them incorrectly will cause problems for you. Some injuries, such as tendinitis are inflammatory in nature, so NSAIDS are actually the right tool for the job.

In the cons list (for this answer):

  • They can cause digestive issues.
  • Overuse can cause kidney damage.
  • They thin blood, so they are incompatible with other blood thinning medications

In general; however, the biggest risks with pain killers of any type and training is that they dull your sensitivity to pain. While you are training without pain killers, you can tell the difference between just the dull pain of pushing yourself and an actual injury requiring more attention. With pain killers, the difference in pain is not as obvious. As a result, the person training causes more damage to themselves than they would otherwise.

Pain is an indication that you did something wrong. The only pain that can be safely ignored is Delayed Onset Muscle Soreness (DOMS). Typically, all that's needed is to get the blood flowing again and it goes away. Find out what it is that you are doing wrong and fix it--don't rely on pain killers to keep training. It can be as simple as your shoes being too big (blisters), or developing other issues. Unless you change your habits, you will make things worse.

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The current view in ultra-running circles is that NSAID and the slight dehydration often present in long runs make the risk of rhabdomyolysis too high - hence they are normally not taken.

It used to be the ibuprofen was so commonly taken that it was called Vitamin I. Aid stations would have bowls full of them for runners to take.

In an email to the ultra list, Jennifer Jurynec said:

The problem, as I understand it, with NSAID use is not one of directly causing rhabdomyolysis. Rhabdomyolysis in runners is a consequence of insufficient energy to meet excessive demands with resultant muscle damage that causes a leak of myoglobin ( in addition to other intracellular components) into the blood. Myoglobin, in particular, can have multiple deleterious effects on the kidneys and lead to renal failure if profound enough.

The issue with NSAID's is that they inhibit both cox1 and cox2 pathyways. These pathyways, among other things, are involved with making prostaglandins. Prostaglandins are important for preserving renal artery blood flow. Prostaglandins, under normal conditions, are present in low amounts and are therefore, not the primary thing regulating kidney perfusion. Where they become more important is when either disease is present or the normal kidney milieu is disputed by transient factors. These factors can be DEHYDRATION and electrolyte balance among others.

My opinion is that there are multiple insults to kidneys that fail following an ultrarace. They probably include, rhabdomyolysis, decreased renal perfusion from nsaid use AND dehydration and electrolyte imbalances. I think they all combine to form an unfavorable situation resulting in renal failure. NSAID's in isolation would not cause renal problems unless you have underlying kidney disease or some physical state that results in decreased renal perfusion (such as heart failure).

There are examples of athletes getting rhabdomyolysis such as Erik Skaggs or Don Davis.

However, there are some studies that show that NSAIDs may be protective of the kidneys.

  • Science Daily

    An international research team led by investigators at Vanderbilt University Medical Center reports in the Proceedings of the National Academy of Sciences that acetaminophen prevented oxidative damage and kidney failure after muscle injury in a rat model. The findings support further investigation of the drug's effects in patients with severe muscle injuries.

  • European Journal of Applied Physiology

    Our purpose is to determine whether rhabdomyolysis with myoglobinemia exists during a 48+ h adventure race and if there is a correlation with NSAID use, race time and perceived pain or exertion. Blood samples for analyses of myoglobin (Mb) were collected, and perception of exertion and pain was registered on the Borg-RPE and CR scales, from 20 subjects (3 female, 17 male) Pre-, Mid- and Post-race. Subjects were asked about NSAID use at each sampling and within 12 h pre-race. The result observed was a significant rise in Mb throughout the race, with the NSAID group (n = 6) having significantly lower Mb-Post than the no-NSAID group (n = 14). High Mb-Pre and Post correlated to shorter race time and high Mb-Pre to lower Pain-post. Race time also correlated to NSAID use, with the NSAID group having significantly longer race time than the no-NSAID group. Rhabdomyolysis with myoglobinemia, which might be reduced with NSAID use, exists during a 48+ h adventure race. Indications that high Mb-levels correlate with shorter race time and less pain, and the reasons for the NSAID groups longer race time, warrants further investigation.

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There is one thing that might not be as serious as rhabdomyolysis or kidney damage, but it is far more frequent.

It is the fact that people use NSAIDs as pain killers during training. I am a professional athlete, and to my experience more than 90% of athletes have this habit of taking NSAIDs for DOMS and pain to get through training.

What is the function of pain? To alert the person that something is either inflammed or damaged. By covering that pain during training you put additional strain on an already damaged structure. This puts you at risk of not only futher injuring yourself, but also of overuse through faulty movements or other types of strain that pain would have signaled.

Using NSAIDs during competitions, to rid the pain and achieve maximal performance, is fine. But to use them for that purpose continually can only do harm.

Furthermore, NSAIDs are a frequent causative agent of peptic ulcers. Long-term use puts you at direct risk of this. To further aggrevate the problem is the fact that the sympathetic nervous system gets activated during training, which decreases mucus (protective mechanism for the gastric acid) production in the stomach.

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