rbibbs
01-06-2004, 06:09 PM
First, this is just 'digested data' from websites, I'm not a doctor of internal medicine or a pharmacologist. In prior posts I've mentioned the use of NSAIDS in conjunction with joint inflammation. I got my neck whacked last night in BJJ, so I looked them up again.
NSAIDS (non-steroidal anti-inflammatory drugs) inhibit the production of the cooxygenase enzymes COX-1 and/or COX-2. COX-2 is specific to joint swelling in response to injury or to pathology such as arthritis. COX-1 is specific to the protection of the stomach lining from acid erosion.
Aspirin, ibuprofen, ketoprofen, and naproxen affect both COX enzymes, so they can cause or exacerbate 'heartburn', and are counterindicated when gastric ulcers are present. They are also analgesics, tending to make us less-sensitive to pain.
Celecoxib and Rofecoxib are specific to the COX-2 enzyme. They "shouldn't" affect the integrity of the stomach lining, but a relatively rare side-effect of both is sudden intra-abdominal bleeding, so they're not "harmless", nor are they inexpensively available over-the-counter. (Correcting an earlier post of mine, wherein I crossed mental databases, I didn't find COX-2 inhibitors having 'muscle wasting' as a side effect, but the bleeding side effect can be fatal.)
When a joint is injured, release of COX-2 promotes infusion of fluids into the internal and surrounding joint tissues. If we can inhibit this inflammatory process, we can lessen severity of symptoms and "possibly" hasten recovery.
I say "possibly", because for example, the sinus tissues inflame and release fluids to flush contaminants, and inhibiting the fluid release with the use of antihistamines can somewhat alleviate symptoms, but can also lengthen the duration of infection, because a natural process has been interrupted.
Generally, "the body knows what's good for it", so this fluid infusion into injured joint tissues likely serves "some purpose" in terms of healing. But the body is also known to damage itself by over-reacting... an example being, a fatal histamine reaction to a bee-sting. So the decision to intervene in this inflammatory process, falls upon the individual.
Ice applied to a joint injury also reduces onset of inflammation, and I've never heard of ice being counter-indicated in joint or bruise injuries. But ice has limitations, and even side-effects if overused, i.e., frostbite. Ice 20 min (max) per hour. The sooner after an injury ice is applied, the more effective it is. It's still helpful as long as the injured area feels hotter than surrounding tissue. But never tie an ice-pack to a joint and go to sleep (even if you could).
NSAIDS offer a longer-lasting anti-inflammatory action. There is some contention as to the buildup of anti-inflammatory properties. One site said "takes up to two weeks", the other made no such mention. The way I interpret that, is that to reduce existing inflammation, NSAIDS reach their peak effect after days of uninterrupted use, and that immediate use proximate to the injury can inhibit the initial release of COX-2. A higher authority than myself would have to make that distinction "with certainty". Two week's uninterrupted use of full-dose OTC NSAIDS would likely result in stomach discomfort, if not damage, and should not be undertaken unless under a physician's supervision.
For a bruise or minor joint injury, I use ice, then take one ibuprofen at bedtime. Since I can't take the same injury, and treat it both with and without ibuprofen, I can't establish whether this is effective or not. But it's conservative, and if it is beneficial, this protocol should produce a good ratio of benefit-to-risk.
Rick
NSAIDS (non-steroidal anti-inflammatory drugs) inhibit the production of the cooxygenase enzymes COX-1 and/or COX-2. COX-2 is specific to joint swelling in response to injury or to pathology such as arthritis. COX-1 is specific to the protection of the stomach lining from acid erosion.
Aspirin, ibuprofen, ketoprofen, and naproxen affect both COX enzymes, so they can cause or exacerbate 'heartburn', and are counterindicated when gastric ulcers are present. They are also analgesics, tending to make us less-sensitive to pain.
Celecoxib and Rofecoxib are specific to the COX-2 enzyme. They "shouldn't" affect the integrity of the stomach lining, but a relatively rare side-effect of both is sudden intra-abdominal bleeding, so they're not "harmless", nor are they inexpensively available over-the-counter. (Correcting an earlier post of mine, wherein I crossed mental databases, I didn't find COX-2 inhibitors having 'muscle wasting' as a side effect, but the bleeding side effect can be fatal.)
When a joint is injured, release of COX-2 promotes infusion of fluids into the internal and surrounding joint tissues. If we can inhibit this inflammatory process, we can lessen severity of symptoms and "possibly" hasten recovery.
I say "possibly", because for example, the sinus tissues inflame and release fluids to flush contaminants, and inhibiting the fluid release with the use of antihistamines can somewhat alleviate symptoms, but can also lengthen the duration of infection, because a natural process has been interrupted.
Generally, "the body knows what's good for it", so this fluid infusion into injured joint tissues likely serves "some purpose" in terms of healing. But the body is also known to damage itself by over-reacting... an example being, a fatal histamine reaction to a bee-sting. So the decision to intervene in this inflammatory process, falls upon the individual.
Ice applied to a joint injury also reduces onset of inflammation, and I've never heard of ice being counter-indicated in joint or bruise injuries. But ice has limitations, and even side-effects if overused, i.e., frostbite. Ice 20 min (max) per hour. The sooner after an injury ice is applied, the more effective it is. It's still helpful as long as the injured area feels hotter than surrounding tissue. But never tie an ice-pack to a joint and go to sleep (even if you could).
NSAIDS offer a longer-lasting anti-inflammatory action. There is some contention as to the buildup of anti-inflammatory properties. One site said "takes up to two weeks", the other made no such mention. The way I interpret that, is that to reduce existing inflammation, NSAIDS reach their peak effect after days of uninterrupted use, and that immediate use proximate to the injury can inhibit the initial release of COX-2. A higher authority than myself would have to make that distinction "with certainty". Two week's uninterrupted use of full-dose OTC NSAIDS would likely result in stomach discomfort, if not damage, and should not be undertaken unless under a physician's supervision.
For a bruise or minor joint injury, I use ice, then take one ibuprofen at bedtime. Since I can't take the same injury, and treat it both with and without ibuprofen, I can't establish whether this is effective or not. But it's conservative, and if it is beneficial, this protocol should produce a good ratio of benefit-to-risk.
Rick