Is it OK to take NSAID after a workout? (Read 1603 times)

I've read some bad things about taking anti-iinflammatories and running. Apparently it can cause some serious kidney problems when you're dehydrated. But what if you take them after a run when you're fully hydrated. Does that make any significant difference?

I wouldn't want the ulcers, either. That, and they prolong recovery from injuries. We swell up for a reason.

Quote from renumeratedfrog on 6/13/2008 at 3:07 PM:

I think Trent quoted me on the pain of running. And I have had ITBS. I took a month off from running because of it.

I've been following the NSAID discussion on RA for a while, and decided to get my son's take on it (he's an orthopaedic surgeon specializing in sports medicine, a marathoner, and a former Div I decathlete). Here's his $.02:

NSAIDs can indeed lead to acute renal failure (ARF). There are two types of ARF associated with NSAID use, but I’ll just touch on the one that seems to relate to the arguments on here about running.

As has been stated elsewhere, renal damage is believed to be due to the effect that the medications have on prostaglandins at the afferent arterioles. Prostaglandins normally act to dilate these arterioles, thus allowing greater blood flow to the glomerulus (the collecting unit). By inhibiting these prostaglandins, the afferent arterioles potentially constrict, decreasing the blood flow to the glomerulus and thus leading to ARF.

It is important to note, though, that the effect of prostaglandins themselves is relatively small in individuals without underlying kidney damage, as the basal level of prostaglandin release in the kidneys is relatively low. Consequently, the effect of inhibiting prostaglandins is also relatively small in normal individuals. The problems arise in certain patients with underlying glomerular disease, renal insufficiency, other kidney alterations (including severe volume depletion), or heart disease, in whom the contribution made by prostaglandins increases, and likewise the deleterious effect of inhibiting them is increased.

As with almost all medications, the toxicity seen with NSAIDs is dose-dependent. At over-the-counter doses, renal damage due to NSAIDs is fairly rare. Even at anti-inflammatory doses (e.g., >/= 600 mg ibuprofen 3 times a day), the renal side-effects are almost exclusively encountered in patients with underlying issues as discussed in my previous paragraph.

In summary, here are a few points to consider:
1) NSAID use is generally safe in normal individuals at over-the-counter or anti-inflammatory doses
2) While my experience may be limited, I have never seen (or heard of) a case of NSAID-induced ARF in a healthy individual due strictly to athletic participation while taking an NSAID
3) As with all forms of medical intervention, the risks have to be weighed against the benefits, and certain cautions need to be taken (e.g., stay adequately hydrated while exercising – especially when running a marathon). I wouldn’t take NSAIDs just for the heck of it, but if you feel that you need some type of pain control then I think they are a relatively safe option.

At any rate, while the argument is physiologically sound, I think the clinical effect that an NSAID “…essentially causes the blood to stop flowing to the glomerulus” – is a bit exaggerated (again, speaking strictly about healthy individuals at baseline).

Those are his thoughts, for whatever they’re worth.

BTW--when I was having trouble with my ITB, my orthopod had me on piroxicam for 30 days. That's an ibuprofen on steroids.

Quote from Pron8r on 6/13/2008 at 7:02 PM:

Thank you for that perspective. I should point out, as a general internist, I HAVE seen this many times. It is not unreasonable, I think, to expect that a patient requiring care for acute renal failure would not be referred to an orthopedic surgeon. I would also point out that, again, I am addressing the issue of taking NSAIDS for the aches and pains standard to running. Patients typically who have an orthopedist prescribe NSAIDS have underlying pain-producing diseases. In that case, NSAID therapy in conjunction with other relevant therapies to treat the underlying disease may be indicated. But if you went out and ran 5 hard miles and your thighs ache a bit, well, this is not why we have NSAIDS.

Quote from Gopher Ryan on 6/13/2008 at 7:36 PM:

As I have said in the original linked post, ALL NSAIDS, including aspirin and naproxen, put you at risk.

Thanks to Trent's repeated warnings about NSAIDs I have come to only take them before bed if I'm really hurting and can't sleep. Other than that I sort of enjoy the pain--proof that I've HTFUd. It generally doesn't last too long, anyhow. When it does it usually means that I need to back off on the training for a few days. Better to pay attention to pains that aren't temporary than to mask them and risk more serious injury, IMO.

I used to work with a guy who was an assistant trainer for a local professional soccer team. He said that all adult athletes will wake up in the morning with a little bit of pain. It means that you're using your body! I always keep that in the back of my mind and like you, zoom-zoom, I kind of cherish that little bit of pain.

This thread now has me worried - I'm not sure if I am being sensible or overcautious. What if you wake up a few hours before a run with a headache and take one 220mg Aleve capsule before going back to sleep? Is it best to skip the morning run?