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==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:
* '''''Muscles'''''. <ref name="MuscleTrappe"/>. A 2001 study showed that Ibuprofen and Acetaminiaphen reduce muscle growth after eccentric exercise. Another study<ref name="muscle"/> on muscle damage and NSAIDs showed impaired recovery in the early stages of healing. There was some increased protein synthesis with NSAIDs in latter stages of healing, but the muscles were still weaker 28 days after injury. Other studies<ref name="muscle2"/><ref name="muscle3"/> have shown that four days after injury, NSAIDs resulted in very little muscle regeneration compared with no drugs.* '''''Tendons'''''. A primate study<ref name="TendonPrimates"/> showed "a marked decrease in the breaking strength of tendons at four and six weeks in the ibuprofen-treated animals". Another animal study<ref name="TendonCOX2"/> showed treated tendons were 32% weaker than their untested counterparts. * '''''Bone-Tendon Junctions'''''. An animal study<ref name="tendon"/> of rotator cuff injuries shows that NSAID usage resulted in injuries that did not heal, and those that did heal were weaker than those without NSAID. To quote from the study "Given that NSAID administration was discontinued after 14 days yet affected load-to-failure eight weeks following repair, it appears that inhibition of the early events in the inflammatory cascade has a lasting negative effect on tendon-to-bone healing," Dr. Rodeo said. * '''''Cartilage. ''''' NSAIDs have been shown<ref name="CartilageRabbit"/> to impair the healing of bone and cartilage in rabbits. * '''''Bone fractures. ''''' Tests on rats shows that a NSAID (Celecoxib) in the early stages of bone healing impaired healing, producing a weaker repair.<ref name="bone"/> A study <ref name="BoneLaurence "/> in 2004 declared " Nonsteroidal anti-inflammatory drugs continue to be prescribed as analgesics for patients with healing fractures even though these drugs diminish bone formation, healing, and remodeling".
===Counterpoint===
While there is extensive experimental evidence for NSAIDs impairing healing, there are also some studies that show no change with NSAID use, and a few that indicated improved healing. For instance, one study<ref name="LigamentImprovement"/> showed that using an NSAID for 6 days after injury resulted in a 42% increased ligament strength at day 14, though there was no change by day 21. Another study<ref name="LigamentUninjuredImprovement"/> showed that an NSAID did not change ligament healing, but did improve the strength of the uninjured ligaments. However, my reading indicates that the preponderance of evidence shows NSAIDs impair healing.
=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=
''Main article: [[Delayed Onset Muscle Soreness]]''
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"/>.
[[File:Ibuprofen and GI damage.jpg|none|thumb|500px|The level of a marker of intestinal damage during and after 60 minutes of cycling at 70% [[VO2max|V̇O<sub>2</sub>max]].]]
=NSAIDs and wound healing=
''Main article: [[Popping Blisters]]''
Ibuprofen, and possibly other NSAIDs, impair wound healing and should be avoided<ref name="StadelmannDigenis1998"/><ref name="GuoDiPietro2010"/>.
=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.
<ref name="Smith-1992"> Smith LL. Causes of delayed onset muscle soreness and the impact on athletic performance: a review. J Appl Sport Sci Res 1992; 6 (3): 135-41</ref>
<ref name="Baldwin Lanier-2003"> {{Cite journal | last1 = Baldwin Lanier | first1 = A. | title = Use of nonsteroidal anti-inflammatory drugs following exercise-induced muscle injury. | journal = Sports Med | volume = 33 | issue = 3 | pages = 177-85 | month = | year = 2003 | doi = | PMID = 12656639 }}</ref>
<ref name="StadelmannDigenis1998">{{cite journal|last1=Stadelmann|first1=Wayne K.|last2=Digenis|first2=Alexander G.|last3=Tobin|first3=Gordon R.|title=Impediments to wound healing|journal=The American Journal of Surgery|volume=176|issue=2|year=1998|pages=39S–47S|issn=00029610|doi=10.1016/S0002-9610(98)00184-6}}</ref>
<ref name="GuoDiPietro2010">{{cite journal|last1=Guo|first1=S.|last2=DiPietro|first2=L. A.|title=Factors Affecting Wound Healing|journal=Journal of Dental Research|volume=89|issue=3|year=2010|pages=219–229|issn=0022-0345|doi=10.1177/0022034509359125}}</ref>
</references>