When you’re injured, managing pain can feel like the top priority. It’s tempting to reach for anti-inflammatory medications like ibuprofen or naproxen, commonly known as NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These medications can be very effective for pain and swelling, but did you know that excessive or poorly timed use might actually slow down your body’s natural healing process?
In this blog, we’ll explain:
What NSAIDs do.
How they can impact healing.
How to strike the right balance between pain relief and recovery.
Disclaimer
This blog is for general informational purposes only and is not a substitute for professional medical advice. Always consult with your healthcare provider before starting or stopping any medications or treatments. This blog is general in nature and may help inform a discussion with your doctor but should never replace that discussion. There is so much nuance here that each individual will have differing needs.
What Are NSAIDs and How Do They Work?
NSAIDs block COX enzymes (cyclooxygenase), which are responsible for producing prostaglandins. These prostaglandins play a dual role in the body:
They cause pain, swelling, and fever during injury.
They also support healing, tissue repair, and blood clotting.
There are three main COX enzymes:
COX-1 (Constitutive enzyme)
Always active and involved in producing “housekeeping” prostaglandins.
Functions include:
Protecting the gastric lining (Hence why you must have food and sometimes omeprazol with voltaren!)
Supporting blood clotting
Maintaining kidney function.
COX-2 (Inducible enzyme)
Expressed during inflammation and tissue injury.
Produces pro-inflammatory prostaglandins like PGE2, which amplify pain, swelling, and fever.
Also plays a key role in tissue repair, angiogenesis (blood vessel formation), and bone healing.
COX-3 (Central enzyme)
A variant of COX-1 primarily found in the brain and spinal cord.
Involved in mediating pain and fever but has minimal impact on inflammation.
Paracetamol (acetaminophen) works by inhibiting COX-3, explaining its effectiveness for pain and fever without significant anti-inflammatory effects.
COX Enzyme | Primary Function | Examples of Impact | Inhibitor |
COX-1 | Protects gastric lining, supports clotting, kidneys | Gastric protection, thromboxane (clotting) production | Aspirin, ibuprofen |
COX-2 | Drives inflammation, pain, tissue repair | Pro-inflammatory prostaglandins (e.g., PGE2) | Celecoxib, ibuprofen |
COX-3 | Pain and fever regulation (central nervous system) | Mediates fever and central pain perception | Paracetamol |
Can NSAIDs Delay Healing?
Yes, there is evidence that prolonged or heavy NSAID use can interfere with healing. Here's why:
Inflammation Is Part of Healing
Inflammation isn’t all bad! It’s your body’s natural response to injury. Prostaglandins (especially those produced by COX-2) trigger the repair process by recruiting immune cells and growth factors.
Blocking inflammation too much or for too long can reduce this natural response.
Bone Healing
NSAIDs can impair bone healing by inhibiting osteoblasts (cells that build new bone tissue). This is particularly important for fractures.
Research suggests that high-dose or long-term NSAID use may delay bone healing.
Tendon and Ligament Repair
Tendons and ligaments rely on early inflammation to trigger tissue repair. Studies show that NSAIDs may interfere with collagen production, which is vital for strong and flexible soft tissues.
What About NSAID Use in the First 72 Hours?
The first 72 hours after an injury are critical for healing. This is when the body initiates the acute inflammatory phase, a process that:
Clears damaged tissue.
Recruits immune cells to the injury site.
Signals the start of tissue repair.
Using NSAIDs during this time can reduce swelling and pain, but it may also interfere with the beneficial aspects of inflammation. Research suggests that minimizing NSAID use in the first 72 hours may support better long-term healing outcomes, especially for injuries involving:
Bones.
Tendons.
Ligaments.
If pain is manageable, it may be better to rely on alternatives like paracetamol (a COX-3 inhibitor) for pain relief without disrupting the inflammatory response. For severe swelling or pain that limits function, short-term, low-dose NSAID use (e.g., 1–2 days) may be reasonable, followed by a focus on other recovery strategies. Also consider if you really need to manage the pain. Pain is not always a bad thing. It is a natural part of the human experience that most often will pass with time and sensibility.
Short-Term Use vs. Long-Term Use: The Key Difference
The good news is that short-term, low-to-moderate NSAID use (2–5 days) for acute injuries likely has minimal impact on healing. If you’re dealing with significant pain or swelling, NSAIDs can help you function and stay active – which is often important for recovery.
However, heavy or long-term NSAID use (several weeks or more) may:
Slow healing of fractures, tendons, and ligaments.
Increase the risk of gastrointestinal issues, kidney problems, and delayed tissue repair.
Better Pain Management Strategies
If pain relief is your goal, there are ways to balance effective treatment with optimal healing:
Start with Paracetamol (COX-3 Inhibitor)
Paracetamol (acetaminophen) is a safe and effective option for baseline pain control. It reduces pain and fever but does not interfere with inflammation or healing.
Use NSAIDs Wisely
NSAIDs like ibuprofen or naproxen can be helpful for severe pain and swelling, but limit use to the first 1–3 days after an injury if possible.
Always follow the lowest effective dose for the shortest duration.
Consider Selective COX-2 Inhibitors
Medications like celecoxib target COX-2 more specifically, reducing inflammation and pain without impacting the stomach lining as much.
However, prolonged use of COX-2 inhibitors can still impact tissue repair, so moderation is key.
Non-Medication Options
Gentle movement, ice or heat application, compression, and elevation can help manage swelling and pain naturally.
Osteopathic treatment and physical therapy can support healing, reduce stiffness, and improve function.
Practical Takeaways for Your Healing Journey
Pain Management: Start with paracetamol as your baseline, and only add NSAIDs if needed.
NSAID Use: Avoid during the first 72 hours, if possible, to support inflammation’s role in healing. Limit use to the first 2–5 days after injury, using the lowest effective dose.
Healing First: Allow your body’s inflammation to do its job – it’s a key part of tissue repair.
Consult Your Practitioner: If you’re unsure about pain management or recovery strategies, we’re here to help.
Final Thoughts
NSAIDs can be a helpful tool for pain management, but like any tool, they need to be used wisely. If your goal is to recover fully and get back to your usual activities, consider balancing pain relief with strategies that support healing.
At TLC Osteopaths, we’re here to guide you through recovery with the right treatments and advice tailored to your needs. We are, of course, legally not in a position to advise on medication use or prescribe medication. If you have any questions about managing your pain or healing from an injury, get in touch – we’re here to help!
References
Chen, L., et al. (2013). "Effect of Nonsteroidal Anti-inflammatory Drugs on Tendon Healing: A Systematic Review of Animal Studies." Arthroscopy: The Journal of Arthroscopic & Related Surgery.
Xie, C., et al. (2009). "COX-2 inhibition impairs fracture healing in mice." Journal of Bone and Mineral Research.
Marquez-Lara, A., et al. (2016). "Nonsteroidal anti-inflammatory drugs and bone-healing: A systematic review of research and recommendations for clinical practice." Journal of Bone and Joint Surgery.
Ricciotti, E., & FitzGerald, G. A. (2011). "Prostaglandins and inflammation." Arteriosclerosis, Thrombosis, and Vascular Biology.
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