Does taking ibuprofen for pain do more harm than good?

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An Olympic triathlete and half-Ironman world champion, Joanna Zeiger (left) says not enough athletes know the long-term risks of NSAIDs.

Former pro soccer player Rachel Campanaro (formerly Nuzzolese) collided with a goalie her sophomore year at Wake Forest, spraining her knee. A sports specialist recommended she take two naproxen, a common nonsteroidal anti-inflammatory (NSAID), per day for two months to manage pain and swelling. It wasn't long before she was in gastrointestinal distress, eventually developing gastritis and teetering on an ulcer. Today, the 25-year-old won't go near the medicine.

Knowledge is widespread about the GI distress associated with NSAIDs. Lesser known, but continuing to emerge, is the associated risk to kidneys. Both ailments can be troublesome, but many athletes are loath to give up the medication. They use ibuprofen to get to the start of a race or game if they have a strain or sprain. They swallow it midway through long endurance events, hoping to squelch some of the pain that inevitably comes with the territory. Or they pop pills after a particularly tough workout, hoping to shut down inflammation and recover quickly for the next day.

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Rachel Campanaro, a former pro soccer player, will no longer use ibuprofen to help treat pain, and advises the players she works with as a personal trainer on alternative pain-management methods.

"The issue is that people don't understand the consequences," says  Joanna Zeiger, an Olympic triathlete and half-Ironman world champion. "Or they do, but they don't want to think long term."

The latest research

One of the most recent studies on the topic of NSAID use focuses on its impact on the kidneys during endurance events, specifically ultramarathons. Dr. Grant Lipman, a clinical associate professor of emergency medicine at Stanford University and an ultrarunner himself, wanted to see if ibuprofen was safe for participants at the 50-mile distance.

"I went into this study expecting to discover that NSAID use is perfectly safe in these events," Lipman says. "But that wasn't the case."

The study looked at 89 runners participating in 50-mile races, each taking either an ibuprofen tablet or placebo every four hours during the event. At the end of the races, Lipman took blood draws to check for increased levels of creatinine, an early indicator of the kidney's decreased ability to function properly.

While 44 percent of the ultrarunners had high levels of creatinine -- high enough to suggest kidney injury -- those who took the NSAID were 18 percent more likely to demonstrate elevated levels. "The troubling thing is that 50 to 75 percent of ultrarunners take ibuprofen during these events," Lipman says.

What the experts recommend

Lipman's team didn't do a follow-up study to determine if there is lasting impact on the kidneys, but the initial study certainly raises big warning flags. Lipman has simple advice for those regularly using ibuprofen. "Perhaps try acetaminophen instead," he says.

Dr. Karen Sutton, orthopedic surgeon at Yale University School of Medicine, says that the key with NSAID use is a conservative, responsible approach. "It's important that physicians counsel patients on the fact that they should not use them long term, and that they may cause GI upset," she says. "If you are self-medicating with NSAIDs, talk to your doctor about what the proper dosage might be and how long you should use them."

Sutton would like athletes to protect themselves against damage from the drug class by ensuring proper hydration to help protect the kidneys and by taking the medication with food. "You need something more than an energy gel in your stomach," she says, "even if it's just a cracker."

It's also important to take the right dosage, Sutton says. "Females who participate in endurance events, in particular, have a lower body mass and, therefore, may want to adjust the amount of the medication they take," she explained. "Also, know what supplements and other medications you are taking and whether or not they could have an adverse effect when combined with an NSAID."

What athletes are doing

Campanaro says that, while awareness is spreading about the downsides to NSAIDs, its use is still pervasive. "People still hit it, and they hit it hard," she says. "To my mind, if you can't get through an event without the pain medication, your body is telling you something and it's time to back off."

When she was in heavy training, Zeiger used NSAIDs on occasion post-workout. However, "I never took them during training or a race because I knew the risks," she says. "Today, I still wouldn't use them for exercise. There's a mindset that we need to finish events at all costs. That's an attitude that needs to change."

Campanaro has moved on to alternative methods for treating pain or soreness. Now a personal trainer who works with youth soccer players, she is particularly tuned in to how young athletes treat pain.

"I tell parents all the time that there are other, better approaches," she says. "I want to see players foam rolling, working on mobility and getting in a proper warm-up and cool down."

As an ultrarunner, Lipman understands the desire to "get through" a race or game. Still, he says, "If you need to pop a bunch of pills to do it, maybe you need to examine why or try a different approach."

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