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Anti-Inflammatories: Why, When, and When Not

Doctors report that healing tissue may be helped or hurt by nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are used to reduce pain and swelling. If a broken bone is painful, an NSAID taken for pain may reduce or delay bone healing.

Likewise, bone growth in and around a joint implant can be affected by the newer NSAIDS called COX-2 inhibitors. COX-2s are used to reduce inflammation without causing stomach upset.

In this study doctors reviewed the results of many animal and human studies. They report that indomethacin, aspirin, and ibuprofen all decrease the amount of bone growth around joint implants. They also show how spinal fusion is affected by NSAIDs. Studies show that the fusion rate can drop by as much as half in patients who take NSAIDs for more than three months after spinal fusion surgery. Patients who smoke have an even greater risk of nonunion when using NSAIDs.

On the other hand, COX-2s may have a positive effect on soft tissue and ligament healing. Some studies show that NSAIDs work well for sprains and strains. Patients have less pain when taking these drugs. Injured athletes can train at a higher level when taking them.

More research is needed to study the effects of COX-2 inhibitors on sports-related tendon or ligament injuries. In the meantime, these authors advise doctors to avoid NSAID use when fracture healing or bone fusion is needed.

References: Laurence E. Dahners, MD, and Brian H. Mullis, MD. Effects of Nonsteroidal Anti-Inflammatory Drugs on Bone Formation and Soft-Tissue Healing. In Journal of the American Academy of Orthopaedic Surgeons. May/June 2004. Vol. 12. No. 3. Pp. 139-143.

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