Body Shop: Think twice before using ibuprofen for long-term pain management - Military Off Duty, Army Health, military fitness, army physical fitness - Army Times

Body Shop: Think twice before using ibuprofen for long-term pain management

Life, work, exercise — it can all add up to one big headache. Or back strain, or creaky knees.

For whatever ails you, a bottle of ibuprofen calls to you, surrounded by an inviting golden aura. But before you pop a pill and head to the gym, take a moment to consider whether safe, pain-free living really can be just a tablet away.

Ibuprofen — “Vitamin I” among grizzled athletes — is a nonsteroidal anti-inflammatory drug, a category that also includes aspirin, naproxen sodium (Aleve) and ketoprofen.

They work to reduce pain and inflammation by preventing your body from forming prostaglandins, which can induce swelling and pain with injuries.

Prostaglandins also work to control blood pressure, dilate and constrict blood vessels, protect the stomach lining, and contract and relax smooth muscle fibers.

Regular vs. episodic dosing

Many runners, especially those logging long miles, regularly take NSAIDs to ease pain or even prevent muscle injury before it starts. But regular consumption with exercise should raise a red flag.

“I use ibuprofen on an episodic basis,” said Eric Holt, vice chair of the anesthesiology department at the Uniformed Services University of the Health Sciences and staff anesthesiologist at the National Naval Medical Center in Bethesda, Md. “Four out of five times I run, I don’t need it. But when my bulging disc flares up, I do.”

Holt, who runs three or four times a week based on his swimming and lifting schedule, said he is familiar with pain through both his work and personal experience.

While attached in 2009 to an Air Force special ops unit in Afghanistan, he received traumatic injuries from an improvised explosive device explosion and spent a year recovering.

“I want to do right by my body, so I take the least bit I need to of any medication, from the heavy-duty painkillers administered just after my accident to ibuprofen when my back gives me trouble,” Holt said.

The military’s warrior culture of working through pain may make you feel like regular ibuprofen is necessary to function, but nagging injuries mean it’s time to visit a medical specialist.

“My best advice for someone who’s been self-medicating with over-the-counter products for a month or more is to go to your doctor,” Holt said. “We don’t want you to lose jump status or fly status because of an injury. We’ll work with you.”

Ibuprofen on a run

So what’s the fuss about taking some ibuprofen on a run? It depends.

“Realizing nothing is 100 percent certain, a well-hydrated, healthy person who exercises intelligently — nothing crazy like a summertime, jungle CrossFit quad workout in full body armor — should feel safe following standard ibuprofen dosing recommendations on an episodic basis,” Holt said.

“Higher doses taken with greater frequency, less healthy people, older soldiers and having more than one disease all increase the likelihood of having issues.”

Side effects can include upset stomach, gastrointestinal bleeding, hyponatremia (sodium deficiency in the blood caused by ingesting too much water and not enough electrolytes), rhabdomyolysis (kidney damage) and — contrary to conventional wisdom — increased muscle swelling.

Running 100 miles at a stretch, in a race such as the Western States Endurance 100, may fall outside the realm of exercising “intelligently,” but it does provide an opportunity to observe the human body under intense stress.

From 2002 to 2006, race directors invited Dr. David Nieman, physiologist and director of the Human Performance Laboratory at the North Carolina Research Campus, to study racers as they made their way through the Sierra Nevada of California.

During such a lengthy event, runners experience the stress of long miles, sleep deprivation, dehydration and fatigued muscles.

Nieman found that seven out of 10 runners took ibuprofen at some point before or during the race. Blood work revealed more inflammation in those who took ibuprofen, along with mild kidney impairment and low-level endotoxemia, in which bacteria leak from the colon into the bloodstream.

As for those runners who took NSAIDs before the race in hopes of more pain-free running, Neiman’s researchers said they reported the same levels of pain during the event and muscle soreness after the run as those who took no NSAIDs.

Stuart Warden, director of physical therapy research at Indiana University, has studied the physiological impact of NSAIDs and discovered that taking them regularly can actually slow the healing of injured bones, muscles, ligaments and tendons. Prostaglandins help make collagen, essential to building healthy tissue. When prostaglandins are inhibited, so is recovery.

What to do

If you hurt, by all means seek relief. NSAIDs are effective on a case-by-case basis; just don’t think of them as a cure-all.

Lt. Gen. Eric Schoomaker, the Army surgeon general, chartered a pain management task force in August 2009 to standardize pain care and look at pain management options. The task force includes medical specialists from the Army, Navy, Air Force, Tricare Management Activity and Veterans Health Administration.

One task force directive is to include treatments such as acupuncture and yoga for pain management. The goal “is not to eliminate medication, but rather to possibly decrease the amount and duration of medication used in the treatment of pain,” Schoomaker said.

Other options to explore are chiropractic adjustments, holistic health care and meditation for pain management.