Non-steroidal anti-inflammatories (NSAIDs) are a class of drugs that reduce pain and inflammation. They include common over-the-counter drugs like aspirin and ibuprofen, commonly prescribed drugs like naproxen, more specific cox 2 inhibitors such as etoricoxib, and many others.
 
There’s a common perception that unlike analgesics such as acetaminophen (found in Tylenol) which just mask the pain, NSAIDs can actually help with the healing of injuries by reducing inflammation. Or at least, that used to be the way we saw things.
 
Inflammation - with its characteristic signs of pain, swelling, redness and heat - used to be (at least by many sportspeople) regarded as the evil villain of the sports injury drama. As well as the pain associated with it, there was a common perception that it interfered with the healing process and that getting rid of it would speed up the return to activity. More recently, though, this has been called into question. Rather than being a bad thing, it’s been realized that inflammation was actually an important part of the healing process. It helps to move plasma from the blood into the injured area, and along with it a host of immune cells and proteins that help to clear out damaged or infected tissue and to initiate the process of repair. Inflammation is also associated with muscle growth and repair (and taking NSAIDs may in some cases affect muscle growth following exercise). 
 
Of course, this raises the question of whether trying to get rid of or even reduce inflammation is the right thing to do in general. Might it be that we’re making the injury feel better in the short term, but interfering with healing in the longer term? This way of thinking is currently in vogue - many articles now question the wisdom of trying to reduce inflammation, whether by using ice after an injury, or by taking anti-inflammatory drugs. This line of logic would suggest that taking NSAIDs after an injury could lead to greater tissue weakness in the long term - almost as though by shortcutting the inflammatory process, the body gives us a lower quality repair.
 
To complicate things, though, there are different kinds of inflammation. Sometimes it can become excessive, or go on too long, or lead to greater scar tissue formation (fibrosis), potentially causing loss of function. We don’t, currently have a very good understanding of why this happens in some cases but not in others. In other situations inflammation can be the result of an inappropriate stimulus (such as in auto-immune conditions, for example). Systemic inflammation plays a role in many human diseases, including asthma, various kinds of arthritis, heart disease, and even cancer.
 
What’s the truth here? Is inflammation “good” or “bad”? And does reducing it interfere with or promote healing? This is yet another case where the reality is more complicated than the straightforward “just so” stories that the headlines give us. Inflammation has a myriad of different effects, and in any given case some will be positive; others may be negative. To figure out whether reducing inflammation is a good idea, there’s no short cut - we have to test it in particular cases and see. So let’s look at what this sort of research actually tells us. It turns out that a lot depends on the kind of injury that we’re talking about.
 
NSAIDs and fracture healing
 
There does appear to be some evidence that non-steroidal anti-inflammatory drugs can delay fracture healing. This comes both from animal studies and studies on humans. It can also lead to an increased risk of non-union in some kinds of fractures, which is clearly a potential worry. However, what’s not clear at present is whether this is true for all NSAIDs, or whether some specific drugs have a much greater effect on bone healing than others. This needs more research before we can say for certain what’s going on.
 
NSAIDs and tendon and ligament healing
 
Tendon and ligament healing is a complex process, involving numerous different components. There has been some work that suggests NSAIDs may interfere with certain parts of the process, and aid others. To fully understand the effects of NSAIDs on healing overall, we need to consider how these effects work together - and this is something that is not yet completely understood. Much of the work to date has been done in the laboratory or in animal models. The few trials that have taken place with human subjects are complicated by the use of differing drugs, selection criteria and protocols. Overall, though, there don’t appear to be convincing and consistent effects in either direction. Although this may change with further research, it’s reasonable to suspect that any effect is likely to be small, and may vary depending on which particular drug is used, as well as the overall health and individual characteristics of the patient. Keep watching this space!
 
But, is there even a benefit to taking NSAIDs?
 
NSAIDs are often used for their pain relieving effects, but the question is whether they are any better than other painkillers. Inflammation is not the only cause of pain in sports injuries: it’s now commonly recognized that for most tendon problems, for example, degeneration rather than inflammation may be the primary problem (some have argued that inflammation is often not a factor at all, but recent evidence appears to suggest that it is likely to be involved, alongside other mechanisms).
 
Even where inflammation clearly is present, the benefits of NSAIDs over simple analgesics aren’t clear. For example, some evidence now suggests that acetaminophen may be just as effective as a commonly prescribed NSAID in the treatment of ankle sprains. It typically has fewer side effects than NSAIDs, so it may be the preferred option for many people.
 
The verdict: true under certain circumstances, but still unclear in most cases. It’s probably not worth worrying about unless you have a fracture (in which case it might be); but equally, for many injuries NSAIDs may not give you much of a benefit over and above that of pain relief, for which other options are available.
 
To sum up the current position, here’s a quote from a literature review:
 
“A consensus of multiple data suggests that NSAIDs do produce a modest delay in healing during the acute inflammatory phase, with no long-term difference in healing outcome in epithelial, tendon, or ligament healing, but significant induced delay of bone healing and increased risk of nonunion.”
 
There are many drugs available for pain relief. The choice of which one to take will depend on the particular injury, but also on the general health and individual characteristics of each patient. NSAIDs are likely to be a good choice for some people, but less so for others. For most sports injuries, excluding fractures, any effect on tissue healing is likely to be small; and over the counter medications are relatively safe for the majority of people. If you’re unsure about the decision, though - and especially if you have any underlying medical conditions, or have had bad reactions to NSAIDs in the past, then it’s definitely something you should discuss with your doctor or pharmacist. As with any medication, you should always read the advice on the packet to double check that it’s suitable for you.