NSAIDs

NSAIDs Case Analysis

New Approaches to Soft Tissue Injuries

Non-steroidial anti-inflammatory drugs (NSAIDs) are typically used to reduce inflammation in soft tissue injuries. The past 50 years represent an era of prodigious growth for sport and fitness related activities. Unfortunately, increased participation has contributed to a rise in the number of sports-related injuries and the use of NSAIDs. The majority of these injuries involve soft tissue structures such as muscle, tendon and ligaments. Practitioners in the field of sports medicine have a variety of drugs and other forms of therapy at their disposal for the treatment of acute inflammation secondary to soft tissue injury. These include the non-steroidial anti-inflammatory drugs, cortisol and muscle relaxants.

NSAIDs are administered with the intent to control acute inflammation and relieve pain. This is achieved by inhibiting the production of prostaglandin, a product of arachidonic acid via the cyclo-oxygenase pathway within the cell membrane. Following the acute inflammatory response, a number of prostaglandins are produced of which prostaglandin E2 (PGE2) is particularly catabolic to muscle and the net result is the loss of muscle protein and atrophy. On the other hand, another prostaglandin, E1, reduces inflammatory response and promotes muscle relaxation. In addition, yet another prostaglandin called F2 promotes the growth of muscle when this compound acts synergistically with the hormone insulin. When athletes take these NSAIDs, they inhibit all prostaglandin synthesis. As a result, NSAIDs control inflammation and decrease pain but the muscle is left in a non-regenerative phase.

The glucocorticoids (steroids) are another group of drugs used to treat soft tissue injury. These hormones are very effective in controlling mediators of inflammation and are capable of influencing muscle mass. However, a condition known as Cushing's Syndrome is caused by excessive amounts of corticosteroids, resulting in muscle weakness, atrophy and death of the muscle fibre. Some authors have referred to glucocorticoids as being the hormone targeting soft tissue. This happens by converting proteins to amino acids and then to carbohydrates. This process appears to involve three mechanisms: (1) an increased release of amino acids by the muscle, (2) a decrease of DNA and protein synthesis at the translation level, and (3) a reduction of amino acid uptake in the muscle. To date these drugs are routinely given when the injury persists and the athlete does not respond to a common first line of treatment with NSAIDs.

Ice, compression and elevation are the standard treatments when dealing with acute soft tissue injuries. However, these modalities are only effective at providing anesthesia and preserving cell integrity during the first 24 hours following an injury, and are of little benefit during the recovery phase. Furthermore, recent studies have shown that continued application of cold may exacerbate the inflammatory response and delay healing.

Recently, a new approach to managing soft tissue injuries employs a combination of proteolytic enzymes (Cytolyse) and antioxidants (Life Force Super Antioxidant / Proantho-zyme) or the consumer oriented InfiAid™. This combination, when given within the first 24 hours following acute injury has a down-regulating effect on the acute inflammatory response. This is achieved by the proteolytic enzymes' (Cytolyse) ability to selectively stimulate the production of the antinflammatory prostaglandin E1 and inhibit the synthesis of the pro-inflammatory prostaglandin E2. In addition, the antioxidants (Life Force Super Antioxidant) stabilize the blood vessel wall, which in turn, decreases the amount of edema (swelling) present at the injury site following injury. The antioxidants act by scavenging oxidants and free radicals, and possess a unique ability to preserve collagen molecules, which are a major component of the soft tissue structures and are compromised at the time of injury.

Early pilot studies have revealed that when injured football players were treated following competition with the conventional methods of ice or NSAIDs versus Cytolyse and Life Force Super Antioxidant, they returned to play with more vigor when treated with the latter combination. In a clinical setting, Dr. Tris Trethart, a family physician who uses a complementary nutritional approach, found that anti-oxidants (Life Force) and proteolytic enzymes (Cytolyse) "were extremely useful in the early stages after a sports injury, or for persons recovering from surgical procedures. Also, our preliminary experience indicates that the combination of Life Force Super Antioxidant and Cytolyse have benefited some athersclerosis conditions. NSAIDs are incapable of this type of effect. We have also seen some promising work by Dr. William Donald Kelly, who has worked with cancer patients using proteolytic enzymes and anti-oxidants. We've had good success with conditions such as back strain, disc pain, sciatica and whip lash. With these conditions, the management of the anti-inflammatory process by the proteolytic enzymes and anti-oxidants may well be why we are seeing a positive response."

The therapeutic approach with proteolytic enzymes (Cytolyse) and antioxidants (Life Force Super Antioxidant) is becoming an accepted protocol for the treatment of a number of conditions because of the ability of the compounds to modify the acute anti-inflammatory response and enhance the recovery process, unlike NSAIDs. The consumer oriented Natural Anti-inflammatory contains both proteolytic enzymes and antioxidants.

Brian D. Fisher, Ph.D. is a full professor in the department of Sports Medicine at the University of Alberta in Edmonton, Alberta, Canada. And, Dr. Tris Trethart, M.D. is an integrative medicine practitioner in Edmonton, Alberta, CAN.

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