The tiny white-haired woman put aside the paper she had been reading and glanced at the clock: 6 p.m. Time to start dinner. With a deep sigh, she started to get up. As she started to stand, she involuntarily let out a sharp cry. Her eyes watered momentarily from pain, but she was standing. Her legs felt too bent and weak to hold her as she started toward her kitchen.
Ana had been sitting in the same place for an hour. Good, that was the bell. The exam was over. As she stood up, her knees cracked audibly. She paused for a moment to allow the stiffness in her knees to ease and then was off to her next class.
As Mike dressed for practice, he noticed stiffness in his elbow. Probably the same thing he’d had last month, more tendinitis. He’d ask the coach about taking something for it before the big game.
The boy raced down the sidewalk. His foot hit the edge of the pavement, and he fell, twisting his ankle under him.
These five people, and many others like them, have one thing in common–inflammation. Inflammation is part of many acute and chronic conditions: arthritis, tendinitis, bursitis, sprains, infections, strains, and more. It can (and does) happen to anyone.
What Is Inflammation?
Inflammation is part of the body’s response to injury. The process can be chronic, as it is in a disease such as arthritis. It can be acute, a response to local injury of bone or soft tissue. It can also be a response to infection. It is always a warning sign that damage has occurred.
It can also be the beginning of the healing process. But inflammation itself can cause further discomfort and, possibly, damage if it is ignored.
When part of the body is injured, the inflammatory process begins. Blood vessels enlarge to allow more disease-fighting white cells to reach the site and to promote healing. Fluid containing white cells leaks out into the tissue. Increased blood flow results in swelling and warmth at that spot. The swelling puts pressure on nerves, causing pain.
When a person falls and sprains an ankle, inflammation is a response to the muscle damage. Surrounding tissues swell. The area becomes warm and painful. Within an hour or so, the person is unable to put weight on the injured ankle. Treatment of a sprain includes treatment of the injury itself: immobilization of the ankle, keeping the person from using it for several days to allow the ligament to heal. In addition, the doctor may prescribe medication to reduce the inflammation, to make the patient more comfortable, and to limit further tissue damage.
Anti-inflammatory medications may be prescription drugs or over-the-counter (OTC) preparations. These medicines can be separated into two categories: steroids and non-steroidal anti-inflammatory drugs (NSAIDs).
Steroids like those produced by the adrenal gland have been found to act as anti-inflammatory agents. These steroids reverse the inflammatory response, reducing the swelling and pain. Some steroids that are used for this include cortisone, prednisone, and others.
Synthetic steroids are useful for a short time, but should not be used indefinitely. These compounds affect many other functions of cells and of the body. Occasionally patients receiving steroids develop high blood pressure or become more prone to infection. Emotional changes may occur when steroids are given for a long time.
Because of the possibility of serious side effects, steroids are prescription drugs.
When inflammation is not too severe, or when treatment will be longterm, other anti-inflammatory drugs are usually used. Non-steroidal anti-inflammatory drugs (NSAIDs) are exactly that: drugs that reduce inflammation, but are not related to the steroid compounds. Generally NSAIDs are considered safer and are more commonly prescribed.
The most common non-steroidal anti-inflammatory drug is aspirin. Aspirin is so common that people do not treat it as a serious drug, but it is.
Is many ways, aspirin seems to be an ideal drug for treating inflammation.
* Aspirin is effective.
* It is easily available.
* It is inexpensive.
Aspirin also has some possibly severe side effects. People who use aspirin regularly over a long period of time for inflammation risk developing stomach irritation that could lead to ulcers.
Other NSAIDs have been developed that may have a lower incidence of aspirin’s possible side effects. Examples of these are ibuprofen, naproxen, piroxicam, and indomethacin. Until recently, these drugs were all prescription drugs. Ibuprofen, however, is now available over the counter as well. Ibuprofen, for example, is sold as Ibuprofen, Motrin IB, Advil, and Nuprin. Even though ibuprofen can be purchased without a prescription, it is a drug that can affect a variety of body systems. The warning label on ibuprofen is important reading.
Since there can be some stomach upset with any of the NSAIDs, a patient may be warned to take the drug with meals. Occasionally another medication may be prescribed to be taken with an NSAID to reduce stomach problems.
Now that other NSAIDs and aspirin are available without a prescription, another set of problems arises from people treating themselves. Without a doctor’s order, aspirin, other NSAIDs, and acetaminophen (non-aspirin pain reliever) should not be mixed. Their effects and side effects can add up to trouble. And the dose recommended on the package should be the dose used.
Aspirin and other NSAIDs also lower the ability of blood to clot. This is especially important for people who are taking anti-coagulants.
Remember the woman at the beginning of the story? Her doctor might have her take a certain dose of aspirin or ibuprofen daily for several months or years for her arthritis. The doctor is following up on her, since she has a chronic condition and needs to take an anti-inflammatory drug indefinitely.
Ana (with the stiff knees) also may have a chronic joint problem requiring a constant level of aspirin. Her condition will also be followed by her physician.
Mike, on the other hand, thinks he may again have tendinitis in his elbow. He is not sure; something else might be the problem. Before he starts taking an anti-inflammatory drug, he should have a doctor look at his elbow. If there is something else wrong with his elbow, he could just be covering up the symptoms by taking aspirin or ibuprofen. He could do more damage to his elbow by taking the drug instead of having the actual problem corrected.
A Doctor’s Diagnosis
Especially in treating an injury such as a sprain or tendinitis, the doctor’s diagnosis is important. Sara may think her knee is sprained. By treating herself with an OTC anti-inflammatory drug such as ibuprofen, she may be able to play her next game. But she may have done more damage to the knee than she knows. A few days may not be enough rest to allow her knee to heal completely.
If Sara were to go to a doctor, she would probably be told to stay off the leg for three or four days, keep ice on the knee, keep it elevated, and perhaps to take an anti-inflammatory drug. After a few days, the doctor would probably want to see her again, to make sure the knee was healing properly.
Anti-inflammatory drugs help reduce the pain and swelling of an injury. These drugs are not a substitute for rest or immobilization of an injury such as a sprain. Nor do they take the place of an antibiotic to fight the infection in a cut.
Aspirin and other NSAIDs available without a prescription are generally used for muscle aches and pains. If the pain does not go away, or if other symptoms appear, see a doctor.