When Pain Medicine and Exercise Collide


Sports medicine professionals and others in the medical world continue to voice their concerns about the use of prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) painkillers, many of which contain acetaminophen. To put these concerns into proper perspective, consider the fact that the No. 1 cause of liver failure here in the United States is acetaminophen poisoning.

According to the Centers for Disease Control and Prevention (CDC), women take NSAIDs more frequently and in higher doses than men and, according to a 10-year span of data, more women than men logged a trip to the emergency room as a result of negative painkiller events or died from a prescription painkiller overdose. For reasons unknown, research has shown that women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them longer than men.

As women have increased their participation in athletics and other fitness endeavors, they have pushed their use of painkillers outside the realm of normal everyday aches and pains. Researchers contend that many athletes take NSAIDs before every workout or competition; however, studies indicate that taking these drugs before a workout can increase the side effects typically seen in heavy users. An hour following their ingestion, NSAIDs begin damaging the intestines, causing alterations in a compound known as intestinal fatty acid binding protein (I-FABP). This is how intestinal hemorrhages occur with repeated NSAID use.

Disrupting Recovery Efforts

It’s imperative to have a cool-down period following a tough workout; the body is a network of deeply interconnected systems, all of which are impacted to various degrees by training. Rest and recovery gives muscles, joints, the brain, and all our internal communication systems the time to heal while allowing the nervous system to calm down.

However, taking NSAIDs after exercise reduces the production of muscle satellite cells; these cells form in response to resistance training and connect with existing muscle fibers to form new lean muscle tissue. Lean muscle is a key player in not only healing damaged muscle tissue, but also stimulating our metabolism.

According to Michael Loes, MD, author of Healing Sports Injuries Naturally, 95 percent of sports injuries are minor traumas involving soft tissues (think sprains, strains, contusions, or bruising) which result in inflammation and pain. He explains that taking a drug like ibuprofen actually activates pro-inflammatory chemicals called prostaglandins, which encourages sub-acute inflammation on top of the normal discomfort that can persist up to four weeks or longer.

In addition, recovery efforts may be made worse by a “wind-up phenomenon” in which pain signals are amplified, explains Mellisa St0ppler, MD, PhD. Nerve fibers like muscle tissue get stronger with exercise, which means they become more efficient at transmitting signals to the brain effectively amplifying pain signals even in cases of slight injury. Consequently, the pain feels much worse, even though the injury is not worsening. At this point, pain may be deemed “chronic” and it is no longer helpful as a sign of injury.

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A recent study published in Nature Reviews Neuroscience suggests that chronic pain affects the anatomy of the brain and impairs certain nerve pathways, leading to a negative feedback loop that prevents the brain from releasing its own natural painkillers. However, studies have found that this mishap can be reversed by employing the use of mind/body healing techniques like acupuncture, meditation, and yoga. In fact, a new report out of Boston University revealed that weekly yoga classes relieved pain, improved joint and muscle function, and reduced the need for pain medication.

The bottom line is that focusing only on relieving pain before and after a workout without emphasizing long-term healing literally intensifies pain signals in the body that, in some cases, may be false alarms.

Unintentional Over-Prescribing: A Common Trend

Nearly half of the people who overdose on acetaminophen, the active ingredient in many NSAIDs, do so unintentionally, says Jay S. Cohen, MD. With pills being handed out like candy at hospitals and private clinics (not to mention the easy access of OTCs to combat minor aches and pains) it’s no surprise that many people don’t know exactly how to use NSAIDs properly, and thus overdose accidentally.

What’s even more startling? A study in the American Journal of Emergency Medicine revealed that when doctors prescribed acetaminophen-narcotic combination pain medications to patients, they didn’t warn the patients about other medications containing acetaminophen that they should reduce or discontinue.

Many people who accidentally overdose may not feel the effects in one single dose; however, medical researchers refer to this as a “staggered overdose,” which elicits damage with time (such as liver failure) and initiates the need for a liver transplant. Using acetaminophen-based products as quick remedies for ailments such as toothaches, headaches, back and joint problems, and a cold or flu contributes to this staggered buildup.

It’s a misconception that NSAIDs are only cautioned in patients with existing heart disease-even short-term treatment with most NSAIDs is associated with an increased risk of death. In addition, many doctors already exercise caution when considering NSAIDs for the relief of chronic pain because these drugs increase the risk of ulcers and serious bleeding in the stomach and gastrointestinal tract. Further, researchers at the Duke University Medical Center recently reported that even in healthy individuals, use of commonly available NSAIDs such as ibuprofen, diclofenac, and naproxen are linked to an increased risk of stroke.

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The Role of NAC

Both alcohol consumption and fasting (due to illness, eating disorders like anorexia, or malnutrition) greatly increase the risk of liver injury after ingesting acetaminophen. Fasting decreases levels of glutathione, the most abundant and powerful internal antioxidant naturally present in the body. Glutathione helps the liver detoxify acetaminophen, and in clinical trials it has shown the ability to kill breast cancer cells.

The key nutrient responsible for the production of glutathione is N-acetyl cysteine (NAC). NSAIDs actually kill off the body’s supply of NAC, which is why people who overdose on the drugs are given large doses of NAC when they are brought to the emergency room. While NSAIDs may be appropriate for those treating severe pain, like recovering from surgery or an injury, taking NAC alongside NSAIDs may be beneficial to maintaining the balance.

Forward-thinking medical professionals have petitioned the FDA to include an insert to alert NSAID users about the benefits of NAC, however to no avail. Fortunately, NAC can be purchased at your local vitamin store; but be sure to read labels and choose a trusted brand.

Natural Freedom From Pain

It is preferable to target the underlying cause of pain when considering your treatment options and then choose the option that will best promote your healing.

During his research on sports injuries, Dr. Loes discovered that adding enzymes that break down protein such as bromelain, derived from pineapple, and papain, derived from the papaya plant to post-workout formulas accelerated muscle recovery and greatly reduced inflammatory chemicals that cause pain and swelling. In fact, a recent study published in the Journal of Strength Conditioning and Research indicated that bromelain and papain restored muscle power shortly after exercise, quickly reestablishing that portion of muscle strength it had lost.

Although enzymes typically first seek out food particles to digest, when they are taken on an empty stomach (e.g., after exercise) they immediately begin reversing exercised-induced damage to tissues much like little Pac-Men devouring all sorts of nasty chemicals that cause pain and inflammation. For this reason, sports medicine researchers and even body builders recommend taking a multiple enzyme before and after workouts.

Other natural pain relievers include:

  • Astaxanthin, a potent anti-inflammatory that supports joint and muscle health
  • Cetyl myristoleate, which acts as an anti-inflammatory and lubricates the joints, making it particularly effective for arthritis symptoms as well as other chronic conditions
  • Curcumin, the active ingredient of the spice turmeric, is associated with reduced swelling, inflammation, and pain, and it can reduce the side effects of NSAIDs
  • Ginger, an herb that offers pain relief and possesses stomach-settling properties
  • Evening primrose, black currant, and borage oils, which are all fatty acids that reduce arthritic pain
  • Cayenne, the active compound found in hot peppers, which reduces pain signals by down-regulating the body’s production of substance P, a chemical component of the nerve cells that carry pain signals to the brain
  • DLPA (DL-phenylalanine), a protein known to neutralize enzymes that inhibit the release of endorphins, which are known as the body’s natural morphine
  • White willow bark, which, like aspirin, contains the pain-killing compound salicylic acid; however, white willow doesn’t cause the gastrointestinal distress like its medical counterpart
  • Glucosamine and chondroitin sulfate, two supplements that, when taken in combination, may greatly reduce pain from arthritis and knee and joint problems
  • Hyaluronic acid promotes joint health, repair, and comfort
  • Omega-3 fish oils, fatty acids that can curb pain and, in fact, be nature?s safest and most effective anti-inflammatory
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In the world of fitness and bodybuilding, the goal is to reduce body fat and become stronger. However, in the process, you shouldn’t confuse pain relief with rebuilding and regeneration of muscle because this is what will prevent you from reaching that next fitness level. If for whatever reason you do take NSAIDs for targeted pain management, it’s important to be aware of how much and how often you are staggering your intake with other OTC products that contain acetaminophen. Pain is an important signal that lets the body know something is wrong but whether you’re male or female, athletic or not, using NSAIDs as a preventive measure is not the healthiest option.

Pain management Techniques

Although not on the top of the list for discussions around the water cooler, a number of non-medical protocols definitively reduce pain; unfortunately, in many cases, they are mere afterthoughts. For example, simple stress reduction techniques like acupuncture, hypnosis, meditation, music therapy, relaxation therapy, yoga, and guided imagery may provide relief. Furthermore, aromatherapy, bio-feedback, Epsom salt baths, deep tissue bodywork, hot and cold packs, massage therapy, and magnet therapy can help. Last but not least, give yourself some time to recover. You should have some off days in between your workouts, while getting plenty of sleep. Studies show that people who only sleep four hours per night will find that their pain thresholds drop significantly, says Dawn Marcus, MD. Pain management expert Harris H. McIlwain, MD, notes that when the brain chemical serotonin is depleted from lack of sleep, sensitivity to pain increases and malaise (a general feeling of illness) develops.

George L. Redmon, PhD, ND

George L. Redmon, PhD, ND, is a graduate of the Clayton College of Natural Health (ND) the American Holistic College of Nutrition (PhD) and he received a PhD in administration and management from Walden University. For 20 years, he has specialized in vitamins and holistic healthcare.

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