Question on Ibuprofen: long term effects

[tennisplayer]

I have been taking about 400mg of Ibuprofen (2 Advil caps) before tennis games, for a few years now. I haven't had any problems, even playing 5-6 times per week. However, I recently decided to quit doing this, and just stopped abruptly. The first week felt really awful, with aches and pains after every tennis session, and some loss of explosive power most likely due to increased inflammation of muscles/joints without the Ibuprofen. I'm now doing a lot more warming up (running, dynamic stretching) before tennis, which helps greatly, and I've decided to give up that "edge" I was getting before from Ibuprofen. I was wondering about something that I could not find on the web:

1. Does consistent Ibuprofen use impair the body's natural ability to deal with inflammation? If so, will stopping cold turkey restore this capability?

2. Is Ibuprofen physically addictive, even mildly? I'm sure it is psychologically addictive, like most things that relieve pain and/or create a feeling of well being.

Thanks in advance.

 

[ollinger]

Addiction to ibuprofen does not occur, though some may feel an emotional dependence on it, and the body's "ability to deal with inflammation" (whatever that means) is unlikely to be impaired. The real risk of ibuprofen is kidney problems, including elevated blood pressure, so if you can do without using it regularly, you should.

 

[tennisplayer]

Addiction to ibuprofen does not occur, though some may feel an emotional dependence on it, and the body's "ability to deal with inflammation" (whatever that means) is unlikely to be impaired. The real risk of ibuprofen is kidney problems, including elevated blood pressure, so if you can do without using it regularly, you should.

Thanks. I just threw out the phrase "ability to deal with inflammation" for lack of a better way of stating it. Let me phrase it another way - since Ibuprofen prevents inflammation from building up, will continued use cause the body to produce more inflammation that it would have otherwise in the absence of this painkiller?

In any case, I hope I am done with this habit for good.

 

[ollinger]

no. the inflammation process is not altered over time by the drug.

 

[Consolation]

Thanks. I just threw out the phrase "ability to deal with inflammation" for lack of a better way of stating it. Let me phrase it another way - since Ibuprofen prevents inflammation from building up, will continued use cause the body to produce more inflammation that it would have otherwise in the absence of this painkiller?

In any case, I hope I am done with this habit for good.

The real answer is noone knows. At the moment noone has identified a feedback interaction from nsaids, but there's a lot of ongoing research in the area (related to epithelial inflammatory responses, primarily in cardiac vessels).

There probably isn't a major feedback response, either positive or negative, in a global sense, especially if you limit yourself to soft tissue effects.

 

[GuyClinch]

Advil will limit an athletes ability to create muscle - it's though to interfere with protein synthesis - but this has come out in studies.

A potentially better way to deal with soreness is tart cherry juice as the antioxidants seem to fight inflammation but without the muscle building problem.

I'd be worried about this though:


A case-controlled study suggested that patients who consumed 5000 or more pills containing NSAIDs during their lifetime may be at increased risk of end-stage renal disease.

My advice use ice and cherry juice instead of advil whenever possible.

 

[snvplayer]

One thing that no one has mentioned is GI Bleed from taking Ibuprofen..

If you have high blood pressure, heart failure, or kidney disease, then you want to be careful because ibuprofen can cause fluid retention, so it works against certain types of blood pressure medication.

If you occassionally (1~3 times a week) and 2 pils at a time, you are probably safe...But, if you need to take it everyday, then you may want to talk to your doctor...

 

[Fee]

Does taking 400 mg of advil a day really do anything for inflammation anyway? I thought a buildup of NSAIDs (of any type) was needed to fight inflammation, not just a single dose here and there.

 

[SystemicAnomaly]

Does taking 400 mg of advil a day really do anything for inflammation anyway? I thought a buildup of NSAIDs (of any type) was needed to fight inflammation, not just a single dose here and there.

You beat me to this. From what I understand a single 400 mg dose is going to have very little, if any, anti-inflammatory effect. One needs to ingest 600 or 800 mg doses more than once a day to produce a significant anti-inflammatory response.

The OP might consider a topical IB gel. While some of this may get into the bloodstream, it is possible that it will result in less problems with digestive system or other issues.
.

 

[Say Chi Sin Lo]

Just so people know, 600mg is the MINIMUM anti-inflammatory dose. I don't if there's any anti-inflammatory effect from a 400mg dose.

As far as kidney damage, we're talking about years of consistent use. Which in your case, I'd worry a little. If you're on it for a few months, don't worry about it.

There's no physical/biological attachment to it. But some may feel it on the psychological level, "****'s going to hurt if I don't take it... maybe I should take it prior so I don't have to worry about hurting, and play to my maximum"

There are food you can eat that has anti-inflammatory effect.

 

[ollinger]

No, Sin Lo. That's a little misleading. Kidney EFFECTS that can raise BP occur in as little as a few days taking ibuprofen. Whereas the kidney effects at that point are usually reversible, there's a significant medical literature suggesting that even relatively brief periods of elevated BP during your life can increase stroke risk. And if you take ibuprofen at night, it may be even more problematic as there's also pretty good studies lately correlating nocturnal hypertension even more strongly with stroke risk than daytime BP. Moral of the story: you shouldn't be taking pain medication to play a game. And if you need to, probably better off with tylenol, as its harmful effects (to liver) generally only occur with considerable doses, while the BP effects of ibuprofen can occur with very modest doses.

 

[markwillplay]

I would not take it every day amigo...It is not good for the lining of our stomach....and taking anything like that every day is not good. May not be that bad, but still.... After having been through two hip surgueries and haveing lots of pain here and there, I can tell you that advil works differently for different people. It worked quite well for me but in doses of 800 mg.

By the way, pain is not always your enemy..sometimes being tolerant of some pain is a good thing. Your body is talking to you and you should listen...Ibuprophin prevents you from "hearing" as well if you get my point.

Also, and this is just a fact I don't care what anyone else says here..aftert taking all types of pain meds both percription and over the counter, I can say with certainty that they lower your threshold for pain over the long haul in a negative way. Always having tylenol or ibuporophin in your system dulling pain makes whatever pain you may have without them seem worse..just the way it is. Do what you ahve to do but in the long run, I would try not to take them unless I really felt like I needed to, and then I would take enough to make a difference.

 

[charliefedererer]

There is no evidence that ibuprofen (Motrin, Advil), naproxen (Aleve) or any NSAID significantly alters the amount of inflamation present!!!!!!!!!!!!!!!!!!!!!!!

If so, at least one of the multiple studies on osteoarthritis or rheumatoid arthritis should have shown that taking long term high dose NSAIDS would alter the disease progression. (Arthritis is the best long term disease process to study inflammation.)
http://www.sharecare.com/question/nsaids-slow-arthritis
http://www.artrite.com/treatmentcare/Rheumatoid-Arthritis--Treatment

NSAIDS only block one of the many, many pathways of inflammation. All the other pathways appear to proceed to cause the same amount of inflammation whether NSAIDS were used or not!

So those taking NSAIDS to try and prophylactically prevent inflammatory changes have no basis in fact for doing so.

 

[ollinger]

The long-term course of arthritis is mainly characterized by re-modeling of the joint surfaces. This is not clearly a result of inflammation, and may even CAUSE some inflammation. So looking at the long term course of arthritis doesn't necessarily tell us if inflammation is impacted. For the tennis player, it echos my point above, that you may be better off just trying to reduce pain (if you insist) with something like tylenol, rather than use antiinflammatories.

 

[charliefedererer]

The long-term course of arthritis is mainly characterized by re-modeling of the joint surfaces. This is not clearly a result of inflammation, and may even CAUSE some inflammation. So looking at the long term course of arthritis doesn't necessarily tell us if inflammation is impacted. For the tennis player, it echos my point above, that you may be better off just trying to reduce pain (if you insist) with something like tylenol, rather than use antiinflammatories.

The main point is that because NSAIDs like ibuprofen have been shown in the laboratory to block one of the many anti-inflammatory pathways, many assume that there is a demonstrated overall anti-inflammatory effect at sites of microscopic injury.

Many assume there is a demonstrated ability to block the inflammation that might lead to to the common overuse injuries that affect tennis players, or other athletes.

But there is a lack of evidence they really alter the the amount of total inflammation at any kind of injury or wound.

NSAIDs are just not that potent anti-inflammatory agents.

They are one dimensioninal in their site of action, and the effect of blocking that one pathway likely is overwhelmed by all the other pathways of inflammation.

Osteoarthritis is largely thought of as an overuse process, and might serve as the one widely studied model of the potenial benefits of NSAIDs. Yet, there is no demonstrated long term benefit in preventing disease progression in those on NSAIDs.

(Rheumatoid arthritis is an autoimmume disease, so a whole different process is involved. Nevertheless it is interesting that NSAIDs have not been shown to prevent disease progression.)

I am not aware that anyone has done a study in groups of athletes that has shown that NSAIDs result in a lower incidence of tendonits or any other overuse injury.

NSAIDs like ibuprofen are fairly good pain relievers. The danger is that athletes may "play through the pain" making overuse injuries more likely.

Thus, ironically, NSAIDs may actually have a negative affect on your tendons, ligaments and joints.

 

[tennisplayer]

Thanks, everybody, for your responses. Besides adding to everyone's knowledge, you have definitely confirmed to me that I've made the right decision. My jumbled responses follow...

Haven't tried cherry juice... will give it a shot!

Taking 400mg of Ibuprofen an hour before playing made a huge difference to me. I've also read that the minimum effective dosage is 600mg, but I rarely took that much as a preventative measure. At 5'10" and 160-165 lbs, perhaps I am small enough to be affected by 400mg.

I have been eating some anti-inflammatory foods recently - ginger, fish oil, turmeric, and some other recommendations. I can't tell how effective they are, but I am sure they are helping greatly.

I had my BP measured a few weeks ago while I was still on Ibuprofen, and it was 113/69. This was a couple of hours after tennis. The doctor said this was normal.

When I was having knee problems some years ago, X-Rays showed that my cartilege was fine, so arthritis was ruled out. The pain was apparently due to a slightly damaged meniscus which has since healed.

Charliefederer, that's a pretty interesting finding - all I can say is that while I was taking the Ibuprofen, it seemed to help. But now that it is three weeks since I stopped, and I'm finally able to play without thinking about it, I can appreciate what you are saying. I warm up extensively before playing, and stretch for 20 minutes after, and I don't feel that sore any more.

Again, thanks all for the information - it was exactly what I was seeking!

 

[tennisplayer]

By the way, pain is not always your enemy..sometimes being tolerant of some pain is a good thing. Your body is talking to you and you should listen...Ibuprophin prevents you from "hearing" as well if you get my point.

Also, and this is just a fact I don't care what anyone else says here..aftert taking all types of pain meds both percription and over the counter, I can say with certainty that they lower your threshold for pain over the long haul in a negative way. Always having tylenol or ibuporophin in your system dulling pain makes whatever pain you may have without them seem worse..just the way it is. Do what you ahve to do but in the long run, I would try not to take them unless I really felt like I needed to, and then I would take enough to make a difference.

Agreed - and this is exactly what I was thinking immediately after I gave up on Ibu. With each passing day, the pain/soreness got a little less intense after playing. Today, after one intense set, I feel quite normal. Either my body or mind (or both) adapted, that's for sure.

 

[jswinf]

Rather than start another thread (too lazy) I'll mention a story in today's newspaper about a study indicating men who took a daily acetaminophen (Tylenol, etc.) were less likely to get prostate cancer, and less likely to get "aggressive" prostate cancers. While not an anti-inflammatory, it's a good pain reliever. Any thoughts on chronic use of this? Of course, it's well known to be harmful at high doses.

 

[snvplayer]

Rather than start another thread (too lazy) I'll mention a story in today's newspaper about a study indicating men who took a daily acetaminophen (Tylenol, etc.) were less likely to get prostate cancer, and less likely to get "aggressive" prostate cancers. While not an anti-inflammatory, it's a good pain reliever. Any thoughts on chronic use of this? Of course, it's well known to be harmful at high doses.

Interesting....Why were the men taking Tyrenol? I don't think they could have men take tyrenol for a long time just to test its advere effect...?

Tyrenol takes toll on liver...

 

[SystemicAnomaly]

...

Haven't tried cherry juice... will give it a shot!

Taking 400mg of Ibuprofen an hour before playing made a huge difference to me. I've also read that the minimum effective dosage is 600mg, but I rarely took that much as a preventative measure. At 5'10" and 160-165 lbs, perhaps I am small enough to be affected by 400mg.

I have been eating some anti-inflammatory foods recently - ginger, fish oil, turmeric, and some other recommendations. I can't tell how effective they are, but I am sure they are helping greatly...

600mg doses, 2x or 3x per day, is a minimum dosage for reducing inflammation. However, 400mg can still be an effective dosage as an analgesic for reducing the sensation pain or discomfort (and perhaps has other benefits). I find that 400mg of the liquid-caps can be particularly effective at times for me.

Had forgotten about cherry juice. I've actually suggested cherries and cherry juice a number of times in the past. Green tea can also be helpful. Ginger root, turmeric and fish (salmon, sardines) or fish oil are also foods that I've suggested in the past. Rosemary and holy (sacred) basil can also be useful for reducing inflammation. Holy basil can be is fairly inexpensive in Indian grocery stores under the name, tulsi. note that the more common, sweet basil, is not the same thing.

In my next post, I can talk about improving the bioavailablity of turmeric.
.

 

[Say Chi Sin Lo]

There is no evidence that ibuprofen (Motrin, Advil), naproxen (Aleve) or any NSAID significantly alters the amount of inflamation present!!!!!!!!!!!!!!!!!!!!!!!

If so, at least one of the multiple studies on osteoarthritis or rheumatoid arthritis should have shown that taking long term high dose NSAIDS would alter the disease progression. (Arthritis is the best long term disease process to study inflammation.)
http://www.sharecare.com/question/nsaids-slow-arthritis
http://www.artrite.com/treatmentcare/Rheumatoid-Arthritis--Treatment

NSAIDS only block one of the many, many pathways of inflammation. All the other pathways appear to proceed to cause the same amount of inflammation whether NSAIDS were used or not!

So those taking NSAIDS to try and prophylactically prevent inflammatory changes have no basis in fact for doing so.

I think you're wrong. Not sports related but I did a study on NSAID and lymphedena. And yeah, it does have an effect on inflammation. Yeah, that's my research so I will stand by it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791214/?tool=pubmed

 

[charliefedererer]

I think you're wrong. Not sports related but I did a study on NSAID and lymphedena. And yeah, it does have an effect on inflammation. Yeah, that's my research so I will stand by it.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791214/?tool=pubmed

Congratulations on doing such fabulous work.

It is only with such investigations that more will be known about the potential effects of NSAIDs.

But such laboratory work is very specific to the animal model and specific type of injury sustained. So in your work:

"Creation of Experimental Lymphedema
Tail lymphedema was induced in female hairless, immunocompetent SKH-1 mice (Charles River Laboratories, Boston, MA) as described [5]. The mice were anesthetized with a solution of ketamine, xylazine, and saline (0.07 ml i.p.). The skin of the tail was circumferentially incised 16 mm distal to its base. The major lymphatic trunks were identified by subcutaneous injection of methylene blue distal to the incision and ablated by limited cautery. The mice were carefully monitored for any visceral signs of distress. Sham surgery controls were treated identically, but without lymphatic cautery. Normal controls did not undergo any surgical manipulation. All mice were sacrificed in accordance with American Veterinary Medical Association guidelines for rodent euthanasia after day 11 days of observation."

"Treatment Protocols
Beginning on day 3 after the surgical manipulation, mice with lymphedema received subcutaneous injections of NSAID (ketoprofen, 5 mg/kg; Sigma, St. Louis, MO) (n=12), sTNF-R1 (pegsunercept, 3 mg/kg; Amgen, Thousand Oaks, CA) (n=17), or phosphate-buffered saline (PBS) (n=16) every other day until the day of sacrifice. Sham surgery and normal controls were treated identically with the NSAID (n=8 per group), sTNF-R1 (n=11 per group), or PBS (n=11 normal controls, n=8 sham surgery controls)."

It is therefore hard to know how this type of injury corresponds to the type of injuries incurred by athletes to muscle, tendon, ligament and cartilage that are associated with overuse syndromes.

It is hard to extend data from observations that were terminated at day 11 as to what the final healing process would have looked like.

It is impossible to know if other NSAIDs taken orally would have the same effect as ketoprofen which was injected subcutaneously.


But I fully hope that this work is precisely a step in the direction you write about as follows:

"We propose that uncoupling the deleterious manifestations of inflammation from the desired pro-lymphangiogenic effects of endogenous repair mechanisms is a logical therapeutic strategy. The present study represents a novel and preliminary step toward the development of pharmacotherapeutics for the treatment of acquired lymphedema."

I fully hope that work such as this will one day revolutionize the entire fields of medicine and surgery by an ability to selectively down regulate deletarious inflammatory responses.

Again, thank you for your work, and thank you for taking the time to draw out attention to it by posting here.

 

[Say Chi Sin Lo]

Oh yeah, I never said this can relate directly to muscle injuries, chornic/acute. I'm just saying there are evidence supporting the anti-inflammatory effects of your favorite NSAID.

However non-specific they may be though.