February 17, 2006

Anti-inflammatories May Not Help Tendon Injuries

By Amy Norton

NEW YORK (Reuters Health) - Anti-inflammatory painkillers like ibuprofen and naproxen may be ineffective in many cases of tendon injury, according to researchers.

Pain relievers known collectively as nonsteroidal anti-inflammatory drugs, or NSAIDs, are often used to treat sore muscles and joints because the body's inflammatory reaction to injury contributes to pain.

However, UK researchers write in a new report, there is no reason to believe that NSAIDs aid tendon injuries known as tendinopathy.

Tendinopathy is a general term for disorders of the tendons, bands of fibrous tissue that connect muscle to bone. The Achilles tendon, tendons in the shoulder and the patellar tendon in the kneecap are commonly affected areas.

While the initial injury that leads to these tendon problems may involve inflammation in the first several days, there is no evidence of ongoing inflammation in chronic tendinopathy. Nor is there evidence that NSAIDs are an effective therapy, according to Drs. Merzesh Magra and Nicola Maffulli of Keele University School of Medicine in Hartshill.

"The available evidence would suggest that in the absence of an overt inflammatory process, there is no rational basis for the use of NSAIDs in chronic tendinopathy," the researchers write in the Clinical Journal of Sports Medicine.

What's more, while NSAIDs may bring some pain relief from tendinopathy, there's no evidence that they aid the healing process -- and they may, in fact, hinder it, according to Magra and Maffulli.

Lab research suggests, for example, that while NSAIDs decrease certain inflammatory chemicals, they may increase the production of substances called leukotrienes that could actually further damage the tendon.

Unfortunately, it's hard for doctors, let alone patients, to tell whether an injury is tendinopathy or an inflammatory injury that might be helped by NSAIDs, according to Maffulli.

So the "simplest advice," he told Reuters Health, is to use an analgesic that does not act as an anti-inflammatory, like acetaminophen, the active ingredient in Tylenol and some other brand names.

A visit to the doctor is the best course of action, according to Maffulli, though tendinopathy can be difficult to discern, and many physicians may end up prescribing an NSAID anyway.

But a trip to the physician can open up other therapy options as well. According to Maffulli, tactics that have been shown to help at least some types of tendinopathy include strengthening exercises and topical glyceryl trinitrate patches.

Doctors also often use injections of cortisone, an anti-inflammatory drug. But, Maffulli said, cortisone has the same issues as NSAIDs, and there is evidence that the injections can make tendons more vulnerable to rupture.

SOURCE: Clinical Journal of Sports Medicine, January/February 2006.