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{{DISPLAYTITLE: NSAIDs (Ibuprofen, Acetaminophen/AcetaminophenParacetamol) for runners, impairs healing and interferes with hydration}}
[[File:Extra Strength Tylenol and Tylenol PM.jpg|right|thumb|200px|Acetaminophen (brand names Tylenol, aspirin-free Anacin, Excedrin, and numerous cold medicines)]]
NSAIDs are Non-Steroidal Anti-Inflammatory Drugs, the most common are Ibuprofen (Advil, Motrin), Acetaminophen /Paracetamol (Tylenol, aspirin-free Anacin, Excedrin, and numerous cold medicines) and Aspirin. They work by inhibiting a particular enzyme ([http://en.wikipedia.org/wiki/Cyclooxygenase Cyclooxygenase]) which reduces pain, fever and inflammation. NSAIDs are generally bad for runners, impairing healing, masking symptoms, interfering with hydration and in extreme situations can be life threatening. Ibuprofen use is so common among runners that it is sometimes called "Vitamin I"<ref name="VitaminI"/>.
==NSAIDs and Healing==
The inflammation response of our bodies is a key part of the healing process. Using NSAIDs to reduce the inflammation has been shown to impair healing in different tissue types:
=NSAIDs for Pain Reduction=
The primary purpose of NSAIDs is generally for reducing pain, and they are remarkably effective at achieving this. If you need a painkiller, acetaminophen is probably a better choice than ibuprofen, though be careful as it's easy to overdose on Acetaminophen (see below). Acetaminophen has limited anti-inflammatory properties, so it shouldn't impair healing as much as ibuprofen, but it is still good as a painkiller. Combining acetaminophen or other NSAIDs with [[Caffeine]] further improves their painkilling effectiveness. After a major race I can sometimes have so much leg pain that I can't [[Zeo Sleep Monitor|sleep]] and a little acetaminophen can make all the difference. While the acetaminophen may impair healing somewhat I believe the trade-off in improved [[Zeo Sleep Monitor|sleep]] is worthwhile. After all, the lack of [[Zeo Sleep Monitor|sleep]] itself will impair healing, so it's a reasonable compromise.
=NSAIDs and DOMS=[[Delayed Onset Muscle Soreness]] (DOMS) generally occurs between 24 and 72 hours after unusual or severe exercise, especially eccentric exercise like downhill running. NSAIDS have been shown to increase the pain of DOMS, though they may delay its onset<ref name="DomsNsaids"/>, and NSAIDS may also impair healing from DOMS<ref name="um"/>.=NSAIDs and Racing =
Taking NSAIDs in ultramarathon events can improve performance by reducing pain and acute inflammation, but doing so represents a significant risk. There is some evidence<ref name="wser1"/> <ref name="wser2"/> that many runners taking NSAIDs have the same level of pain and greater damage markers compared with non-users. This may be because the runners push themselves to a similar level of pain, with the NSAIDs allowing them to do more damage.
* It seems likely that NSAIDs will increase the risk of injury rather than reducing it, as the symptoms of damage will be masked.
* Taking NSAIDs in marathon or shorter races is probably ineffective as the level of damage seen is not as great as in ultramarathon events.
* If you need NSAIDs to start a race, you probably should not compete.
=Longer Term NSAID usage=
Using NSAIDs for longer periods of time can lead to serious health problems and can be fatal. I have a running friend who had a bleeding ulcer from using Ibuprofen, which is a known<ref name="IbuprophenSideEffects"/> side effect. The likelihood of a bleeding or perforated ulcer goes up with time, from 1% after 3-6 months, to 2-4% after 12 months. 35% of long term Ibuprofen users get an ulcer<ref name="Famotidine"/>, which is are grim odds.
=Acetaminophen Overdose Danger (AKA Paracetamol, Tylenol)=
Acetaminophen does not have the same risk of ulcers, but it is linked to liver damage, especially in those who drink alcohol. Acetaminophen is the leading cause of acute liver failure<ref name="AcetaAcuteLiver"/><ref name="Staggered"/>. There are concerns<ref name="AcetaNormalDoseLiver"/> that even the standard dose can cause changes in liver function. Acetaminophen can cause delayed symptoms<ref name="Staggered"/>, with people seeking medical help up to 5 days after the overdose (20% < 12 hours, 35% 12-24 hours, 45% 24 hours+). Overdoses of Acetaminophen can be caused by taking slightly too much over several days, with the toxicity building up<ref name="Staggered"/>. This problem is again exacerbated by those taking alcohol with Acetaminophen<ref name="Staggered"/>. (One factor that increases the risk is that some common medications, such as cold remedies, include Acetaminophen. If people do not add in the dose of Acetaminophen from these other sources, it is easy to unwittingly exceed the safe dosage.)
<ref name="rhabdoGenes">Recurrent rhabdomyolysis in a collegiat... [Med Sci Sports Exerc. 2006] - PubMed - NCBI http://www.ncbi.nlm.nih.gov/pubmed/16540825</ref>
<ref name="siadh"> http://www.sciencedirect.com/science/article/pii/S0002934307001672</ref>
<ref name="DomsNsaids">B-Com Web https://b-com.mci-group.com/Abstract/Statistics/AbstractStatisticsViewPage.aspx?AbstractID=107621 </ref>
<ref name="um">Ultrarunning magazine, May/June 2010, "Dealing with DOMS"</ref>
</references>
