Pharmacologic considerations in the treatment of injured athletes with nonsteroidal anti-inflammatory drugs.

OBJECTIVE: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to relieve discomfort and enhance the rate of recovery from athletic injuries. A clear understanding of general pharmacologic principles may help the health care professional to optimize therapeutic outcomes and minimize undesirable effects. Such principles include onset and duration of drug action, potency, half-life, steady state, and the impact of exercise and disease on drug absorption, metabolism, and excretion. DATA SOURCES: I searched the MEDLINE and CINAHL data- bases from 1983 to 1997 for the terms "anti-inflammatory drugs," "NSAIDs," "sports medicine," "injury," and "rehabilitation." DATA SYNTHESIS: The NSAIDs exert their mechanism of action primarily through the inhibition of arachidonic acid metabolism. A basic understanding of this mechanism on the part of the health care professional facilitates an understanding of potential side effects and drug interactions, especially those related to increased blood clotting time, diminished kidney function, and occurrence of gastrointestinal discomfort. The effectiveness of NSAIDs in increasing the rate of healing and relieving pain and inflammation can be affected by variables such as the extent of injury, drug dosing, duration of therapy, and the specific drug used. CONCLUSIONS/RECOMMENDATIONS: SOME GENERAL THERAPEUTIC CONCEPTS THAT SHOULD BE CONSIDERED BEFORE USING NSAIDS INCLUDE THE FOLLOWING: (1) Only 1 of these agents should be used at a time in a patient. (2) They should preferably be given with food. (3) Specific outcomes should be delineated. (4) Each patient's physical condition and medical history should be considered before NSAIDs are instituted.