Rolling with the Breaks There are plenty of good reasons to avoid extended or everyday use of nonsteroidal anti-inflammatory drugs (NSAIDs). In several e-Alerts and HSI Members Alerts we've told you how NSAIDs (such as aspirin, ibuprofen, and COX-2 inhibitors) have been shown to contribute to liver and kidney impairment, gastrointestinal problems, and even an increased risk of congestive heart failure. Now a new study demonstrates that if you fracture a bone, an NSAID is not the best choice for managing pain. Fortunately, there's a natural alternative that's much safer. In the most recent issue of the Journal of the American Academy of Orthopaedic Surgeons, two researchers from the University of North Carolina School of Medicine (UNC) review several studies that examine the use of NSAIDs as analgesics for patients recovering from fractures. One of the studies - as reported in the Journal of Bone Joint Surgery (2000) - compared the recovery of nearly 100 patients who had fractured a femur (the long bone that runs from the hip to the knee). The fractures of 32 subjects healed improperly and were classified as "nonunion," while fractures repaired correctly in a control group of 67 subjects. The researchers found a significant association between the use of NSAIDs and the nonunion of fractures. More than 60 percent of the nonunion group reported regular NSAID use compared to only 13 percent in the control group. Among the subjects who used NSAIDs, the average healing time was a full two months longer than among those who used no NSAIDs at all. Based on this and other similar studies, the UNC researchers concluded that during the healing of fractures, NSAIDs should be avoided. They also noted that COX-2 inhibitors not only have an adverse effect on bone healing, but may also impair the healing of ligaments. It's one thing for a researcher to crunch some numbers and recommend that NSAIDs not be used to manage fracture pain. But that same researcher might have a different opinion if he were to suddenly find his own femur in two pieces rather than one. The problem is, there aren't a lot of pain relief alternatives out there. Acetaminophen isn't an NSAID, and it can be an effective pain killer, but as I've mentioned in previous e-Alerts (most recently, "Flick of the Wrist" 1/19/04), acetaminophen products can create health problems that are arguably worse than those of NSAIDs. A safe alternative to both acetaminophen and NSAIDs is a natural agent called bromelain, which we wrote about extensively in both the June 1999 and October 1999 Members Alerts. Bromelain is an enzyme found in pineapple, and it's been shown to reduce pain, inflammation, and swelling, AND help thin the blood as well. Some people are allergic to bromelain, and ulcer patients should avoid using it. For most people, however, bromelain is free of side effects. A dose of 500 mg, taken three times each day, is typical for general pain management. But before starting a bromelain regimen, you should consult an M.D. or healthcare professional who's knowledgeable about alternative medicine. In most cases, supplements are absorbed most effectively when taken with meals. But bromelain is the exception to that rule. In the e-Alert "Water Works" (9/16/03), I told you about an important bromelain tip from HSI Panelist Dr. Richard Cohan, D.D.S., M.B.A. In an e-mail, Dr. Cohan wrote, "I believe that it is important that you draw the distinction between bromelain's activity as a digestive aid when consumed with a meal, and its effectiveness as a pain modulator when consumed before a meal or three hours thereafter (depending how much fat was consumed and therefore how long digestive juices are present in the stomach). It apparently has no effect on pain when consumed with a meal." So if you do use bromelain to control pain after a fracture, save it for between mealtimes and you may end up healing faster and more effectively than if you use an NSAID. Sources: "Effects of Nonsteroidal Anti-Inflammatory Drugs on Bone formation and Soft-Tissue Healing" Journal of the American Academy of Orthopaedic Surgeons, Vol. 12, No. 3, May-June 2004, ncbi.nlm.nih.gov | 
