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NSAIDs and Running

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=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 such as racing a marathon or downhill running. NSAIDS The use of NSAIDs to prevent or treat DOMS has been widely researched, with somewhat mixed results. Even scholarly reviews of the research have been shown differing conclusions<ref name="Cheung-2003"/> <ref name="Smith-1992"/> <ref name="Baldwin Lanier-2003"/><ref name="Howatson-2008"/>. My conclusions based on the available research are:* The most common NSAIDs (Ibuprofen, Acetaminophen (Paracetamol), and Aspirin) are unlikely to help with DOMS. * There is some evidence that Naproxen may be more effective than the common NSAIDs. There is not enough evidence to increase reach a conclusion on Diclofenac, Codeine, Rofecoxib, Ketoprofen, or Bromelain.* If an NSAID is taken for DOMS, it should probably be taken immediately after the damaging exercise rather than waiting until the soreness develops. * It seems likely that taking an NSAID for DOMS will reduce the pain muscular growth that would normally occur as part of the recovery. ** In one study, rabbits treated with flurbiprofen after DOMSinducing exercise regained more strength after 3-7 days, though they may delay its onsetbut between days 7 and 28 days the treated rabbits became weaker while the controls became stronger<ref name="DomsNsaidsMishra-1995"/>. This is only one study, and NSAIDS may also impair healing from on animals, but it is rather troubling as none of the human studies look at the results over this time period. =A Summary of the Research on NSAIDs and DOMS=The table below summarizes the research I located on the effect of NSAIDs on DOMS in humans. I've only considered the primary DOMSmarkers of soreness (pain) and weakness, rather than including things like blood enzymes. {| class="wikitable"!NSAID!!Soreness!!Weakness|-|Ibuprofen|7xNo<ref name="Grossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="Stone-2002"/> 2xYes<ref name="Hasson-1993"/><ref name="pmid12580656"/>|8xNo<ref name="umGrossman-1995"/><ref name="Pizza-1999"/><ref name="RahnamaRahmani-Nia2005"/> <ref name="KrentzQuest2008"/><ref name="Arendt-NielsenWeidner2007"/><ref name="Donnelly-1990"/><ref name="pmid12580656"/><ref name="Stone-2002"/> 1xMaybe<ref name="Hasson-1993"/>|-|Acetaminophen (Paracetamol)|2xNo<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>||-|Aspirin|2xYes<ref name="Riasata-2010"/><ref name="Francis-1987"/>2xNo<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>|2xNo<ref name="Riasata-2010"/><ref name="Francis-1987"/>|-|Naproxen |4xYes<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>1xNo<ref name="Bourgeois-1999"/>|3xYes<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>1xNo<ref name="Bourgeois-1999"/>|-|Diclofenac |Possible slight reduction<ref name="DonnellyMcCormick1988"/>||-|Codeine|1xNo<ref name="Barlas-2000"/> ||-|Rofecoxib |1xNo<ref name="LoramMitchell2005"/> ||-|Ketoprofen |1xYes<ref name="Sayers-2001"/>|1xYes<ref name="Sayers-2001"/>|-|Bromelain |1xNo<ref name="Stone-2002"/>||}  
=NSAIDs and Intestinal Damage=
As little as one hour of intense cycling can result in indications of small intestinal damage<ref name="van Wijck-2011"/>. This is believed to be due to the redirection of blood away from the digestive system and towards the active muscles. These markers are significantly higher if 400mg ibuprofen (the standard single adult dose) is taken before the exercise<ref name="VAN Wijck-2012"/>. The marker used is Plasma Intestinal Fatty Acid Binding Protein which is an early marker of intestinal necrosis<ref name="Vermeulen Windsant-2012"/>.
<ref name="van Wijck-2011"> {{Cite journal | last1 = van Wijck | first1 = K. | last2 = Lenaerts | first2 = K. | last3 = van Loon | first3 = LJ. | last4 = Peters | first4 = WH. | last5 = Buurman | first5 = WA. | last6 = Dejong | first6 = CH. | title = Exercise-induced splanchnic hypoperfusion results in gut dysfunction in healthy men. | journal = PLoS One | volume = 6 | issue = 7 | pages = e22366 | month = | year = 2011 | doi = 10.1371/journal.pone.0022366 | PMID = 21811592 }}</ref>
<ref name="Vermeulen Windsant-2012"> {{Cite journal | last1 = Vermeulen Windsant | first1 = IC. | last2 = Hellenthal | first2 = FA. | last3 = Derikx | first3 = JP. | last4 = Prins | first4 = MH. | last5 = Buurman | first5 = WA. | last6 = Jacobs | first6 = MJ. | last7 = Schurink | first7 = GW. | title = Circulating intestinal fatty acid-binding protein as an early marker of intestinal necrosis after aortic surgery: a prospective observational cohort study. | journal = Ann Surg | volume = 255 | issue = 4 | pages = 796-803 | month = Apr | year = 2012 | doi = 10.1097/SLA.0b013e31824b1e16 | PMID = 22367448 }}</ref>
<ref name="Riasata-2010">Riasati et al.: Aspirin and delayed onset muscle soreness ASPIRIN MAY BE AN EFFECTIVE TREATMENT FOR EXERCISE- INDUCED MUSCLE SORENESS | ResearchGate http://www.researchgate.net/publication/228091056_Riasati_et_al._Aspirin_and_delayed_onset_muscle_soreness_ASPIRIN_MAY_BE_AN_EFFECTIVE_TREATMENT_FOR_EXERCISE-_INDUCED_MUSCLE_SORENESS </ref>
<ref name="Francis-1987"> {{Cite journal | last1 = Francis | first1 = KT. | last2 = Hoobler | first2 = T. | title = Effects of aspirin on delayed muscle soreness. | journal = J Sports Med Phys Fitness | volume = 27 | issue = 3 | pages = 333-7 | month = Sep | year = 1987 | doi = | PMID = 3431117 }}</ref>
<ref name="Donnelly-1990"> {{Cite journal | last1 = Donnelly | first1 = AE. | last2 = Maughan | first2 = RJ. | last3 = Whiting | first3 = PH. | title = Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage. | journal = Br J Sports Med | volume = 24 | issue = 3 | pages = 191-5 | month = Sep | year = 1990 | doi = | PMID = 2078806 }}</ref>
<ref name="DonnellyMcCormick1988">{{cite journal|last1=Donnelly|first1=A E|last2=McCormick|first2=K|last3=Maughan|first3=R J|last4=Whiting|first4=P H|last5=Clarkson|first5=P M|title=Effects of a non-steroidal anti-inflammatory drug on delayed onset muscle soreness and indices of damage.|journal=British Journal of Sports Medicine|volume=22|issue=1|year=1988|pages=35–38|issn=0306-3674|doi=10.1136/bjsm.22.1.35}}</ref>
<ref name="Hasson-1993"> {{Cite journal | last1 = Hasson | first1 = SM. | last2 = Daniels | first2 = JC. | last3 = Divine | first3 = JG. | last4 = Niebuhr | first4 = BR. | last5 = Richmond | first5 = S. | last6 = Stein | first6 = PG. | last7 = Williams | first7 = JH. | title = Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. | journal = Med Sci Sports Exerc | volume = 25 | issue = 1 | pages = 9-17 | month = Jan | year = 1993 | doi = | PMID = 8423760 }}</ref>
<ref name="Grossman-1995">Effect of Ibuprofen Use on Delayed Onset Muscle Soreness of the Elbow Flexors http://journals.humankinetics.com/jsr-back-issues/jsrvolume4issue4november/effectofibuprofenuseondelayedonsetmusclesorenessoftheelbowflexors </ref>
<ref name="Dudley-1997"> {{Cite journal | last1 = Dudley | first1 = GA. | last2 = Czerkawski | first2 = J. | last3 = Meinrod | first3 = A. | last4 = Gillis | first4 = G. | last5 = Baldwin | first5 = A. | last6 = Scarpone | first6 = M. | title = Efficacy of naproxen sodium for exercise-induced dysfunction muscle injury and soreness. | journal = Clin J Sport Med | volume = 7 | issue = 1 | pages = 3-10 | month = Jan | year = 1997 | doi = | PMID = 9117523 }}</ref>
<ref name="Barlas-2000"> {{Cite journal | last1 = Barlas | first1 = P. | last2 = Craig | first2 = JA. | last3 = Robinson | first3 = J. | last4 = Walsh | first4 = DM. | last5 = Baxter | first5 = GD. | last6 = Allen | first6 = JM. | title = Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics. | journal = Arch Phys Med Rehabil | volume = 81 | issue = 7 | pages = 966-72 | month = Jul | year = 2000 | doi = 10.1053/apmr.2000.6277 | PMID = 10896014 }}</ref>
<ref name="Pizza-1999"> {{Cite journal | last1 = Pizza | first1 = FX. | last2 = Cavender | first2 = D. | last3 = Stockard | first3 = A. | last4 = Baylies | first4 = H. | last5 = Beighle | first5 = A. | title = Anti-inflammatory doses of ibuprofen: effect on neutrophils and exercise-induced muscle injury. | journal = Int J Sports Med | volume = 20 | issue = 2 | pages = 98-102 | month = Feb | year = 1999 | doi = 10.1055/s-2007-971100 | PMID = 10190769 }}</ref>
<ref name="SmithGeorge1995">{{cite journal|last1=Smith|first1=Lucille|last2=George|first2=Robert|last3=Chenier|first3=Thomas|last4=McCammon|first4=Michael|last5=Houmard|first5=Joseph|last6=Israel|first6=Richard|last7=Hoppmann|first7=R. A.|last8=Smith|first8=Susan|title=Do over-the-counter analgesics reduce delayed onset muscle soreness and serum creatine kinase values?|journal=Research in Sports Medicine|volume=6|issue=2|year=1995|pages=81–88|issn=1543-8627|doi=10.1080/15438629509512039}}</ref>
<ref name="Baldwin-2001"> {{Cite journal | last1 = Baldwin | first1 = AC. | last2 = Stevenson | first2 = SW. | last3 = Dudley | first3 = GA. | title = Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. | journal = J Gerontol A Biol Sci Med Sci | volume = 56 | issue = 8 | pages = M510-3 | month = Aug | year = 2001 | doi = | PMID = 11487604 }}</ref>
<ref name="pmid12580656">{{cite journal| author=Tokmakidis SP, Kokkinidis EA, Smilios I, Douda H| title=The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise. | journal=J Strength Cond Res | year= 2003 | volume= 17 | issue= 1 | pages= 53-9 | pmid=12580656 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12580656 }} </ref>
<ref name="Stone-2002"> {{Cite journal | last1 = Stone | first1 = MB. | last2 = Merrick | first2 = MA. | last3 = Ingersoll | first3 = CD. | last4 = Edwards | first4 = JE. | title = Preliminary comparison of bromelain and Ibuprofen for delayed onset muscle soreness management. | journal = Clin J Sport Med | volume = 12 | issue = 6 | pages = 373-8 | month = Nov | year = 2002 | doi = | PMID = 12466693 }}</ref>
<ref name="RahnamaRahmani-Nia2005">{{cite journal|last1=Rahnama|first1=N|last2=Rahmani-Nia|first2=F|last3=Ebrahim|first3=K|title=The isolated and combined effects of selected physical activity and ibuprofen on delayed-onset muscle soreness|journal=Journal of Sports Sciences|volume=23|issue=8|year=2005|pages=843–850|issn=0264-0414|doi=10.1080/02640410400021989}}</ref>
<ref name="KrentzQuest2008">{{cite journal|last1=Krentz|first1=Joel R.|last2=Quest|first2=Braden|last3=Farthing|first3=Jonathan P.|last4=Quest|first4=Dale W.|last5=Chilibeck|first5=Philip D.|title=The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training|journal=Applied Physiology, Nutrition, and Metabolism|volume=33|issue=3|year=2008|pages=470–475|issn=1715-5312|doi=10.1139/H08-019}}</ref>
<ref name="HyldahlKeadle2010">{{cite journal|last1=Hyldahl|first1=Robert D.|last2=Keadle|first2=Justin|last3=Rouzier|first3=Pierre A.|last4=Pearl|first4=Dennis|last5=Clarkson|first5=Priscilla M.|title=Effects of Ibuprofen Topical Gel on Muscle Soreness|journal=Medicine & Science in Sports & Exercise|volume=42|issue=3|year=2010|pages=614–621|issn=0195-9131|doi=10.1249/MSS.0b013e3181b95db2}}</ref>
<ref name="Arendt-NielsenWeidner2007">{{cite journal|last1=Arendt-Nielsen|first1=Lars|last2=Weidner|first2=Morten|last3=Bartholin|first3=Dorte|last4=Rosetzsky|first4=Allan|title=A Double-Blind Randomized Placebo Controlled Parallel Group Study Evaluating the Effects of Ibuprofen and Glucosamine Sulfate on Exercise Induced Muscle Soreness|journal=Journal Of Musculoskeletal Pain|volume=15|issue=1|year=2007|pages=21–28|issn=1058-2452|doi=10.1300/J094v15n01_04}}</ref>
<ref name="Trappe-2011"> {{Cite journal | last1 = Trappe | first1 = TA. | last2 = Carroll | first2 = CC. | last3 = Dickinson | first3 = JM. | last4 = LeMoine | first4 = JK. | last5 = Haus | first5 = JM. | last6 = Sullivan | first6 = BE. | last7 = Lee | first7 = JD. | last8 = Jemiolo | first8 = B. | last9 = Weinheimer | first9 = EM. | title = Influence of acetaminophen and ibuprofen on skeletal muscle adaptations to resistance exercise in older adults. | journal = Am J Physiol Regul Integr Comp Physiol | volume = 300 | issue = 3 | pages = R655-62 | month = Mar | year = 2011 | doi = 10.1152/ajpregu.00611.2010 | PMID = 21160058 }}</ref>
<ref name="LoramMitchell2005">{{cite journal|last1=Loram|first1=L.C.|last2=Mitchell|first2=D.|last3=Fuller|first3=A.|title=Rofecoxib and tramadol do not attenuate delayed-onset muscle soreness or ischaemic pain in human volunteers|journal=Canadian Journal of Physiology and Pharmacology|volume=83|issue=12|year=2005|pages=1137–1145|issn=0008-4212|doi=10.1139/y05-113}}</ref>
<ref name="Howatson-2008"> {{Cite journal | last1 = Howatson | first1 = G. | last2 = van Someren | first2 = KA. | title = The prevention and treatment of exercise-induced muscle damage. | journal = Sports Med | volume = 38 | issue = 6 | pages = 483-503 | month = | year = 2008 | doi = | PMID = 18489195 }}</ref>
<ref name="Lecomte-1998"> {{Cite journal | last1 = Lecomte | first1 = JM. | last2 = Lacroix | first2 = VJ. | last3 = Montgomery | first3 = DL. | title = A randomized controlled trial of the effect of naproxen on delayed onset muscle soreness and muscle strength. | journal = Clin J Sport Med | volume = 8 | issue = 2 | pages = 82-7 | month = Apr | year = 1998 | doi = | PMID = 9641434 }}</ref>
<ref name="Mishra-1995"> {{Cite journal | last1 = Mishra | first1 = DK. | last2 = Fridén | first2 = J. | last3 = Schmitz | first3 = MC. | last4 = Lieber | first4 = RL. | title = Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function. | journal = J Bone Joint Surg Am | volume = 77 | issue = 10 | pages = 1510-9 | month = Oct | year = 1995 | doi = | PMID = 7593059 }}</ref>
<ref name="Sayers-2001"> {{Cite journal | last1 = Sayers | first1 = SP. | last2 = Knight | first2 = CA. | last3 = Clarkson | first3 = PM. | last4 = Van Wegen | first4 = EH. | last5 = Kamen | first5 = G. | title = Effect of ketoprofen on muscle function and sEMG activity after eccentric exercise. | journal = Med Sci Sports Exerc | volume = 33 | issue = 5 | pages = 702-10 | month = May | year = 2001 | doi = | PMID = 11323536 }}</ref>
<ref name="Trappe-2002"> {{Cite journal | last1 = Trappe | first1 = TA. | last2 = White | first2 = F. | last3 = Lambert | first3 = CP. | last4 = Cesar | first4 = D. | last5 = Hellerstein | first5 = M. | last6 = Evans | first6 = WJ. | title = Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. | journal = Am J Physiol Endocrinol Metab | volume = 282 | issue = 3 | pages = E551-6 | month = Mar | year = 2002 | doi = 10.1152/ajpendo.00352.2001 | PMID = 11832356 }}</ref>
<ref name="Bourgeois-1999"> {{Cite journal | last1 = Bourgeois | first1 = J. | last2 = MacDougall | first2 = D. | last3 = MacDonald | first3 = J. | last4 = Tarnopolsky | first4 = M. | title = Naproxen does not alter indices of muscle damage in resistance-exercise trained men. | journal = Med Sci Sports Exerc | volume = 31 | issue = 1 | pages = 4-9 | month = Jan | year = 1999 | doi = | PMID = 9927002 }}</ref>
<ref name="journals.ut.ac.ir"> {{Cite web | last = | first = | title = The Effect of Taking Naproxen Drug on the Level of Perceived Pain and Changes of CPK Serum after Eccentric Exercise - Harakat Volume: 37, Issue:| url = http://journals.ut.ac.ir/page/article-frame.html?langId=en&articleId=1003701| publisher = | date = | accessdate = 3 January 2013}}</ref>
 
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