Discussion: NSAIDs not so helpful

From the last paragraph:

When, then, are ibuprofen and other anti-inflammatory painkillers justified? "When you have inflammation and pain from an acute injury," Warden says. "In that situation, NSAIDs are very effective."

That's pretty much when I take 'em. It's pretty rare to get through a 24-hour adventure race without some minor bumps. I usually wait to see if it's starting to swell before taking anything, but sometimes you know right away.

It's pretty rare to get through life without some "minor" bumps, even if one stays out of 24-hour adventure races. I take vitamin I for inflammation and pain from an acute injury, but not prophylactically.

At the advice of fairly athletic physicians, I take vitamin I prophylactically ONLY WHEN the race is likely to be long (my threshhold is 20K/6 hour rogaine) AND there is already a small injury - even one for which I would otherwise have stopped taking it.

This seems to work well for me. I have gotten through some longer races when I was worried that the injury might have flared up. It may be a placebo effect; I don't care as long as it works.

In a number of studies conducted both in the field and in human performance laboratories in recent years, NSAIDs did not lessen people's perception of pain during activity or decrease muscle soreness later. "We had researchers at water stops" during the Western States event, Nieman says, asking the racers how the hours of exertion felt to them. "There was no difference between the runners using ibuprofen and those who weren't. So the painkillers were not useful for reducing pain" during the long race, he says, and afterward, the runners using ibuprofen reported having legs that were just as sore as those who hadn't used the drugs.

So runner A is suffering more than runner B and runner A takes some ibuprofen. It helps a little. They come into the aid station and both report that they feel like shit. Conclusion according to this article is the ibuprofen made no difference. No consideration given to how runner A might have felt without it.

Is this bad science or bad journalism, or both? Makes me wonder about everything else in the article.

Probably some of both, but my guess is that it's more bad journalism. If you read the study on which the article was based (I'll admint I only read the abstract because you have to pay for the article and I really don't care that much), it appears that they are using only questionaires and not a true control-group/double-blind sample. However, it also appears that the authors understand the limitations of such sampling and have adequately toned down their findings. Journalists, even those rare ones who really understand how to read an academic paper, necessarily hype the findings because it simply makes a better story.

Maybe it's just bad journalism, but the science sounds very shaky too. Or maybe I should say trying to make something appear scientific.

I've run Western States, and I've been in those situations where they come and pester you for info as to how you're doing, and the only thing I ever felt they were doing that might be scientific was drawing blood. No vague perception issues here about trying to quantify how someone feels on the 0 to 10 shit scale (just somewhat shitty all the way to please just shoot me). And I might not be honest about how I feel on the shit scale because the docs have the right to pull you from the race, or hold you, for any reason, and saying you feel bad might just be that reason.

And they want to know what you've taken for NSAIDs, and damned if you can remember, and damned if you're necessarily going to tell them the right answer anyway, especially if you've taken a lot.

So more reasons why this is bogus. And they doesn't include maybe the person asking the questions is a cute chick and you're just lying through your teeth about how great you feel, and they're writing it all down. Seriously. Because you need to have a little fun to make up for how bad you feel.

The best part of the blood test deal was the year, way back, when they sent the blood to the lab, and the race director got a call a day later from the lab director, just wanting to clarify if the samples were from people who were still alive or not. He thought they were, but the samples had some readings that were way way off the charts, CPK I think?, a marker of muscle damage, like after a massive heart attack. I think the next year he knew what to expect.

Well... there goes part of my race strategy for the weekend. Any ideas if paracetamol (just mask the pain rather than trying to reduce the inflammation) has any significant side effects??

From my own experience, but also wearing my professional hat as a pharmacist:

Ibuprofen - heartburn/indigestion, fluid retention, tends to affect my temperature and salt regulation in long/hot races. Makes you bruise and bleed more easily. If used too often you may develop stomach ulcers. To get through a race you could take a couple, but it's better to rub anti-inflammatory gel just on sore spots that really need it. Don't use any antiinflammatories for acute sprains or strains because you will worsen bleeding into the tissues.

Paracetamol - pretty benign but you MUST NOT take more than 4 grams of paracetamol (usually 6-8 paracetamol-containing tablets) in any one day or your liver can self-destruct. This includes the brands with codeine built into them. May make you a bit more thirsty or constipated but that's about it, otherwise. Not specifically anti-inflammatory, but work for most aches, generally okay for sprains.

ibuprofen/codeine combination products = pure evil

jenny - what about voltaren?

Thanks Jenny. I can relate to many of the symptoms you describe in long races, but have had similar without/ earlier in race than ibuprofen consumption... rarely take them at all between races.

Also interested in the voltaren (which sometime seems to have worked wonders on acute injuries and sometimes has seemed to do nothing...)

Diclofenac, which is Voltaren(R), doesn't kick in as quickly, but its effects last a bit longer. The pills (in Aust) come with a coating that means you may not get indigestion. The whole family of NSAIDS are such close cousins - basically, they're all related to aspirin - that you'll potentially get the same effects (good and bad) from all of them, but some people may have stronger stomachs than others. Some people come out in a rash, too. I find Feldene (piroxicam) gel useful, but have pretty much given up on Nurofen (ibuprofen) because it's not cool to have bleeding gums when cleaning your teeth the week after a rogaine.

Ta