Most of us have taken anti-inflammatory drugs at some point: From Advil to Excedrin to pharmacy-brand ibuprofen or naproxen, they can help with fever, headaches, back pain, and muscle cramps after the gym. But research links this class of drugs, also known as NSAIDs, to an increase in stomach problems, ulcers, kidney failure, heart attacks, and stroke. According to experts, the truth about anti-inflammatory drugs is that when used properly, they are generally safe — but you should avoid them if you can. In other words: NSAIDs should be your last resort. Here's what you need to know when it comes to deciding whether or not to pop a pill to relieve your pain.
The New Risks
This past July, the FDA called for stronger warnings on NSAID labels and more attention to side effects after reviewing the body of research showing the drugs could cause a higher risk in heart attack and stroke. "It was known for a long time that all the drugs in this category carry some small risk with regard to heart attack and stroke," says urologist Dr. Joseph Alukal at NYU Langone Medical Center. "But certain patients are at a higher risk. The older gentleman, the smoker, someone who's had heart or stomach problems before — you'd be sure to tell that guy to be careful." But for a man who's in good shape and taking a pill after a sore workout, Alukal says his risk of a heart attack or stroke would be low.
Don't Take Anti-Inflammatories as a Precautionary Measure
Here's one that might seem obvious: stop taking ibuprofen and the like as soon as you're pain free. "That's the right time to come off the drug," says Alukal. If someone is particularly active, he adds, and they're not experiencing any pain but have been taking the NSAID for months, stomach ulcers or other problems may develop. "I remind that guy that he can't take those drugs forever. What he needs to do is rest, nothing is more important — and to see a sports specialist or orthopedist to see if he has an underlying injury."
And Don't Mindlessly Take Them After A Race
In a 2006 study, David Nieman, director of the Human Performance Lab at Appalachian State University found that endurance athletes who took chronic ibuprofen during training and competition — the top choice for the runners studied — didn't lessen their pain after a workout anymore than those who took nothing. In fact, taking ibuprofen often worsened their inflammation and oxidative stress after the big race, and contributed to mild kidney damage. "We've been telling runners ever since that ibuprofen and long endurance running don't mix well at all together, and to avoid these drugs," Nieman says. He adds that there's even some research showing NSAIDs can block some of the signaling in your body that help your muscles build and adapt to exercise. "That's bad for anybody training, since the ibuprofen isn't really helping them in any way and may be blocking some of the actual molecules that need to be expressed in order for the muscle to become bigger, stronger, and handle oxygen better," says Nieman.
Alternative Treatments for Athletes
Nieman suggests exploring alternative pain therapies first, especially flavonoids found in green tea, berries, apple skin, and other fruits and vegetables. "For athletic pain, NSAIDs aren't the way to go. We're telling athletes don't use NSAIDs because of the damage and instead to have fruits and vegetables, drink a lot of green tea, eat a lot berries and fish," Nieman says. "What's interesting about polyphenols is they have a subtle, long-term effect — they don't work like drugs. They get into the tissue and help the body prevent disease." Alukal also suggests ice and heat as your first go-to for muscle pain. "Ice and heat are very good ways to treat inflammation, muscle aches and pain, and carry next to no risk."