No Pills, No Pain

Pills in Paper CupThe “No Pills, No Pain” Philosophy

Ultimately, the goal of any treatment is to get you feeling better. At first glance, pills seem to be the quickest and easiest way to reach this goal. But taking certain medications not only slow healing but actually encourage you to damage yourself more because you can’t feel the pain that tells you that you are hurting yourself. Slowing down and giving your joint the time it needs to begin to heal is the first step in minimizing ongoing tissue damage and allow healing and recovery to occur.

What are NSAIDS?

NSAIDs are a class of drugs that can relieve pain, decrease inflammation, reduce fever, and act as a blood thinner. This group contains many common drugs including Advil, Aleve, Ibuprofen, Nuprin, aspirin, Indocin, Daypro and Voltaren. Additionally, there is a new subclass of these drugs called COX-2 inhibitors. This subclass, which contains the drug celecoxib (Celebrex), shares many of the characteristics of general NSAIDS, although they also have some unique characteristics and problems.

Although NSAIDs and COX-2 inhibitors are very good for some medical problems, when they are used for joint pain, they often create more problems than they solve.

What are the problems with using NSAIDs or other pain relievers?

NSAIDs block pain – When you take an NSAID, you feel better because the drug blocks the feelings of pain that your body is producing. However, NSAIDs do not get rid of the cause of the pain; they only keep you from feeling it for a while. Pain is your body’s way of telling you that something is wrong and damage is being done to some part of your body. When you don’t feel the pain, you may use the injured area more and cause greater damage because you’re not feeling the pain. When the medication wears off, the pain is often worse than before. Or, if you keep taking the pain pills while continuing to use it, eventually the pain gets so bad that you can feel it even while you are taking the drugs. If treated properly, many pains can be resolved and the damage reversed. If you wait until the pain, and therefore the damage, is much worse, it may be much more difficult to not only eliminate the pain but more importantly, heal the injured tissues.

NSAIDs have side effects – NSAIDs can cause a variety of stomach and intestinal problems. The most common are fairly mild, like heartburn, which can be uncomfortable, but not very serious. But in some patients, more serious conditions like bleeding into the G.I. system can occur. Although this condition is uncommon, it can lead to serious complications and death. It was estimated in the New England Journal of Medicine article that 16,500 deaths occur in the United States every year that are related to NSAID use.

NSAIDs can actually slow healing – Multiple studies have shown that using NSAIDs can slow the healing of broken bones, damaged ligaments, and other tissues. If you are trying to heal the damage done to a knee, shoulder, or other joint, using NSAIDs can significantly lengthen your healing time. One of the major claims of NSAIDs is that they are an “anti-inflammatory.” In some people, like those with rheumatoid arthritis, blocking the inflammatory process is an important part of treating the disease. However, in healthy people, the inflammatory response is part of the body’s normal process in healing injuries. By blocking inflammation, NSAIDs can actually delay the healing process. These are the reasons we don’t recommend taking medication to mask joint and muscle pain.

What Can I Do?

Is there something I can take at night, when the pain won’t let me sleep?

Tylenol (acetaminophen) – Tylenol is not an NSAIDs but it is a good painkiller. It does not have the same effect of slowing down tissue healing, although it has its own toxicity problems. In some cases, it can cause liver damage, especially if too much is taken.  But if you must take an over-the-counter painkiller, it is usually a better choice than an NSAID. However, since it will block pain, it can lead to the same cycle of using an injured part and thereby increasing its damage (as well as increasing the need for more medication) that NSAID use can cause.