Non-steroidal anti-inflammatory drugs (NSAIDs) in sports medicine. Guidelines for practical but sensible use.

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in sports medicine. NSAIDs have known anti-inflammatory, analgesic, antipyretic, and antithrombotic effects, although their in-vivo effects in treating musculoskeletal injuries in humans remain largely unknown. NSAIDs analgesic action is not significantly greater than paracetamol for musculoskeletal injury but they have a higher risk profile, with side-effects including asthma exacerbation, gastrointestinal and renal side-effects, hypertension, and other cardiovascular disease.

The authors recommend an approach to NSAID use in sports medicine whereby simple analgesia is preferentially used when analgesia is the primary desired outcome. However, based both on the current pathophysiological understanding of most injury presentations, and the frequency that inflammation may actually be a component of the injury complex, it is premature to suppose that NSAIDs are not useful to the physician managing sports injuries. The prescribing of NSAIDs should be cautious, and both situation and pathology specific. Both dose and duration minimization should be prioritized and combined with simple principles of protection, rest, ice, compression, elevation (PRICE) which should allow NSAID-sparing. NSAID use should always be coupled with appropriate physical rehabilitation.

NSAIDs are probably most useful for treating nerve and soft-tissue impingments, inflammatory arthropathies, and tenosynovitis. There are not generally indicated for isolated chronic tendinopathy, or for fractures. The use of NSAIDs in treating muscle injury is controversial. Conditions where NSAID use requires more careful assessment include; ligament injury, joint injury, osteoarthritis, haematoma, and post-operatively.