June 20, 2018
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Tough pill to swallow: Common painkillers do more harm than good

By Dr. Michael Noonan, Special to the BDN

When you work in health care, especially wellness care, you get used to irony.

For years, doctors recommended hormone replacement therapy to prevent breast cancer, only to find it actually causes it. Low-fat foods and artificial sweeteners contribute to weight gain because you never feel full from eating them. Hydrogenated or “trans” fats that we were told were a healthy alternative to saturated fats are now known to be a major contributor to heart disease and diabetes.

But as a chiropractic doctor, the irony that gets to me the most involves anti-inflammatory drugs like Motrin (ibuprofen), Aleve (naproxyn), Vioxx, aspirin, and Toradol. This class of drugs is called NSAIDs, for Non-Steroidal Anti-Inflammatory Drugs. These drugs are very popular medications in the U.S. Many of my patients use them on a regular basis, often daily, and many have used these drugs at this frequency for years.

There is plenty not to like when it comes to side effects of NSAIDs — stomach irritation and perforation, heart disease, kidney damage, even (gasp!) the dreaded erectile dysfunction. But there is another side effect of these drugs that is not well known. Here is the first irony: NSAIDs may actually interfere with healing.

Several studies have shown that injured animals given NSAIDs had less complete healing than those that didn’t. This includes both fractures and soft tissue injuries. Similar results have been seen on reviews of human cases as well.

Many of my patients have a hard time with this idea. How could a drug that stops inflammation be bad? Haven’t we been reading reports that inflammation is behind heart disease, arthritis, even cancer? Isn’t inflammation harmful?

The answer is not a simple yes or no. In chiropractic school we were taught that inflammation is the first stage of the healing process, and it’s a necessary one. But if it does not resolve, and turns chronic, it becomes a source of stress to the tissues, leading to damage and eventual disease.

NSAIDs may not resolve inflammation so that the next step in tissue repair can occur; it is likely that they just stop the whole process. That means the damage may not be completely healed, even though you feel better. Since inflammation causes pain, when the pain stops you tend to assume the injury is done healing.

So the next question would be, why are NSAIDs so popular? It has been estimated that in the U.S. alone we consume 30 billion doses of NSAIDs every year.

Why do we feel so much need to stop inflammation? The answer is really pretty simple — it is our lifestyles, especially our diets, and the fact that we are so sedentary. Foods tend to be either “pro-inflammatory” or “anti-inflammatory” and you can probably guess where our modern diets fall on that spectrum. All food from grains, including bread, bagels, pancakes, etc.; meat from grain-fed animals; processed foods like chips and soda; vegetable oils; and fried foods strongly promote inflammation.

Whole, unprocessed vegetables and fruits (juices don’t really count due to the processing involved), olive oil, and grass-fed meats are anti-inflammatory. So our current diets are very much on the pro-inflammatory side, which helps explain why we consume so many anti-inflammatory drugs.

Of course, most NSAIDs are taken for muscular and joint pain. This is the second irony of long-term NSAIDs use: Much of it is completely unnecessary.

As a doctor of chiropractic, joint and muscle pains are exactly the types of problems I specialize in treating. A major cause of this type of pain is too much sitting. Even when we were children, we sat for several hours a day at school, putting unnatural stresses on not only our low backs but also our necks and upper backs. Few patients escape the “forward head posture” and tight low back that result from so much time spent in a chair. Unfortunately, once the joints and muscle problems have “crossed the line” and become chronic, they usually require active treatment to resolve.

Treating these mechanical problems with a chemical treatment (NSAIDs) will never do more than give temporary relief. I have found these problems respond best to a course of joint and muscle treatments, along with progressive exercises to first loosen up, and then strengthen, the core muscles that hold us upright.

Most of our patients are able to reduce or even eliminate their NSAIDs use after a course of care, and they do even better if they improve their diets. So you can get the treatment, do the exercises, improve your diet, and get off the NSAIDs, or you can continue to use them and run the risk of side effects. To me that is a simple choice, but for so many patients who have been trained to treat every problem with a drug, it can be a difficult pill to swallow.

Dr. Michael Noonan practices chiropractic, acupuncture and other wellness therapies in Old Town.

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