Do Anti-inflammatories Work?

It would appear that according to the research evidence anti-inflammatories are indeed effective for pain relief but have shown no proven benefit in actually reducing the signs of inflammation, such as swelling, in a sprained ankle for example.

So, the answer is yes, but not in the way most of us would expect.

In a recent British Journal of Sports Medicine podcast, the effectiveness, use and safety of these commonly used drugs are discussed. The research would suggest that Paracetamol may be as effective in alleviating pain so this should be tried first as it has a lower risk of side effects.

The best pain relief may be achieved by combining Paracetamol with an anti-inflammatory such as ibuprofen (Neurofen) and often a lower dose of the anti-inflammatories is therefore required, thereby reducing the risk of side effects.

Anti-inflammatories are regularly used in sports injuries, despite no evidence to suggest they allow for a quicker return to sport.

They have been shown to be very helpful in easing pain associated with Osteoarthrosis of the knee and for this condition diclofenac (Difene) shows the best results according to research.

There is also some evidence for topical anti-inflammatories rubbed into the overlying skin in treating tennis elbow. However those who applied a placebo gel also reported a significant reduction in pain for this condition. Topical anti-inflammatories can also be applied to the painful area in osteoarthrosis of the knee. The drawback to topical anti-inflammatories is cost as they tend to be more expensive than those taken by mouth.

Side effects

There are two types of anti-inflammatories based on the mechanism of action. They are non selective and newer generation selective Cox 2 inhibitors. Both can cause gastrointestinal side effects such as ulcers, abdominal pain and upset stomach but when using selective Cox 2 inhibitors this is less likely. A non selective anti-inflammatory can be prescribed with a proton pump inhibitor to reduce risk of these side effects. Over the counter anti-inflammatories tend to be non selective and care should be taken if using for a prolonged periods, especially if causing stomach upset. If this is the case you should discuss using them with your GP.

All anti-inflammatories carry risk of heart attack and other cardiovascular side effects, with the exception of naproxen. This has lead to the ‘black box’ warnings on medicine boxes in the United States. However these negative effects seem to be very dose dependant and those on lower doses of anti-inflammatories for shorter periods of time are at very low risk.

In summary

It seems that anti-inflammatories are good for pain relief, but possibly no better than Paracetamol. There is little evidence to suggest they reduce swelling associated with inflammation. Topical anti-inflammatories work very well but cost may be a drawback. Always use the lowest dose of anti-inflammatory possible for the shortest periods to reduce the risk of side effects.

by Simon.