Dr. Dan Davis discusses injury prevention and treatment, as well as general health and fitness, to help keep you on the court. A look at non-steroidal anti-inflammatory medications and other remedies for pain and inflammation due to injury

Q: What causes the kinds of pain officials encounter due to injury?

A: Pain can be caused by inflammation and also by a contusion (a direct, blunt blow or continuous blows to a muscle) or a basic trauma.

Q: What is inflammation?

A: Inflammation can be a response to an injury. Inflammation is also one of the ways the body tries to heal itself. It, too, can result from an acute episode of some sort of chemical reaction inside the body. There are different varieties of pain – sharp acute pain, chronic pain, and pain associated with where it occurs in the body. Inflammation can be thought of in that context as an “itis” such as inflammation of the bursa (bursitis), inflammation of a tendon (tendonitis), etc. So, when you look at different types of inflammation, you have to figure out how to best treat the inflammation, especially if it affects quality of life and inhibits your ability to pursue the activities you want to pursue, such as officiating basketball. Some medications, such as Tylenol, relieve pain but not inflammation. Others relieve inflammation but not pain. Some do both.

Q: Why would you not want to relieve both?

A: Sometimes pain is a good thing because it provides a signal. It is your body’s way of telling you (and your doctor) that something is wrong and needs attention. If your medication masks the pain, what’s wrong with the body remains wrong, but you have no signal to tell you that is the case.

Q: Aren’t steroids often prescribed to relieve both pain and inflammation?

A: Yes, steroids are designed to do so. But steroids are particularly strong anti-inflammatory medications and over time can break down the body. They can adversely affect the adrenal glands as well as the body’s mechanisms for defending against infection. So we want to avoid steroids if possible. Sometimes you don’t have a choice -- for example, when someone is afflicted with pulmonary fibrosis. It’s a condition whereby the lungs can’t expand, and you are unable to take a deep breath. You take steroids to knock down the inflammation. With Crohn’s disease or colitis, inflammation can cause a blockage which, if untreated, can be fatal, and you need steroids to reduce that inflammation. But, if you must be on steroids for a specific medical reason, you don’t want to have to be on them too long.

Q: What is an alternative to steroids?

A: There are a number of non-steroidal, anti-inflammatory drugs, or NSAIDs, that can do the job, depending on the nature of the pain and inflammation that needs to be treated. Some NSAIDs are over-the-counter medicines, such as Advil or Aleve or any brand of aspirin. Others, such as Celebrex, require a prescription.

Q: How do you determine which to recommend?

A: One thing to take into consideration is that there are two inflammatory pathways in the body that cause pain. We refer to them as Cox 1 and Cox 2. Without getting too technical, let’s just say that some medications are designed to be Cox 1 inhibitors and others Cox 2 inhibitors, and they each work differently. For example, Advil has its own way of knocking out the Cox 1 inflammatory cycle, but it doesn’t work for everyone. Aleve takes a different pathway to knock out the Cox 1 inflammatory cycle, but it too might not work for everyone. One drug that covers both Cox 1 and Cox 2 is a prescription drug called Mobic. Another factor is how long each dose has a positive effect. The longer you can keep inflammation down, the better chance you have of breaking the pain cycle, and that’s a good thing. Motrin lasts about 4 hours, but Aleve is designed to work up to 12 hours.

Q: What are the pros and cons of these meds?

A: There are potential side effects. For example, aspirin can be rough on the stomach lining and in time can cause stomach ulcers. Like aspirin, both Advil and Aleve have nothing to protect the stomach, and that can be a problem. Advil can also adversely affect the kidneys. Vioxx was designed to be up to 50 times stronger in relieving Cox 2 inflammation. But the higher doses caused cardiac toxicity and led to heart failure. Vioxx has since been taken off the market. Today, every non-steroidal anti-inflammatory comes with a black box warning that too high a dose of any of these can cause cardiac toxicity. A black box warning is a warning required by the Food & Drug Administration and must appear on the product’s package with its side effects associated with that medication.

Q: Aren’t there some highly effective topical remedies, such as patches?

A: There are topical anti-inflammatories that relieve inflammation sometimes as well if not better than oral medications. One is Voltaren gel. Another topical anti-inflammatory is a Flector patch. The gel will last 4-6 hours upon application. The patch will last up to 12 hours, and it is applied directly to the area of the body where there is pain and inflammation. In other words, these anti-inflammatories are site-specific. Topical anti-inflammatories provide a nice alternative for people with sensitive stomachs.

Q: What are your overall recommendations for treating pain and inflammation?

A: Any time you have inflammation in soft tissue or continuous pain in any part of the body, that is not a normal condition and you should see your doctor. If you have acute pain, you should probably take a good anti-inflammatory – prescription or non-prescription. Take the medication that is safest for you and that will allow you to continue the activity level you wish to continue. For example, if you just need enough pain relief to help you get through a basketball game, then a couple of Advil or Motrin tablets would probably be sufficient; 400 miligrams is a normal dose, but you could go up to 800 mgs. Definitely do not take as much as 3,200 mgs of Motrin in a single day. For longer periods between doses you might consider Aleve which gives up to 12 hours of relief for both pain and inflammation. Be sure to take Aleve with food. If pain continues on a daily basis, see a doctor for the appropriate medication. Whatever you end up taking, make sure your doctor monitors you as long as you take it.