What to keep in mind if aspirin, ibuprofen or naxopren helps you get on the playing field

Dear GeezerJock Doc: I've been using ibuprofen to treat my back pain for a year, so I can continue to jog. Should I be worried about using this drug so often?

The GeezerJock Doc responds: Ibuprofen is an NSAID, which is short for a non steroidal anti-inflammatory drug. The NSAID classification distinguishes this class of drugs from steroids, which are the first known anti-inflammatory drugs. These steroids are nonanabolic; they are not the steroids that various athletes have been accused of taking in order to hit opposing running backs harder or home runs farther.

The most commonly known steroid is cortisone. Doctors prescribe cortisone and its derivatives to treat acute inflammatory states such as those seen in asthma or poison ivy, to name a few. The classic and original NSAID is aspirin. Aspirin has many uses, ranging from headache treatment to heart attack prevention.

But using aspirin as an NSAID requires high doses and can be accompanied by many side effects. This is why researchers developed alternative NSAIDs over the years. Initially, these new NSAIDs were all prescription medications, but now we all have either ibuprofen (known by its brand names Advil, Nuprin or Motrin) or naproxen (Aleve) in our medicine cabinets.

The recommended doses for over-the-counter usage are not the same doses that I as a physician prescribe for treating a patient who has inflammation. For an anti-inflammatory effect, a patient requires higher doses. At lower doses these medications don't treat inflammation; instead, they function as pain relievers, which is how they are marketed.

Over the years researchers developed a second class of NSAIDs. These drugs, which included Cox-2 inhibitors such as Vioxx and Celebrex, were developed in response to some of the unwanted side effects of the original NSAIDs. This second class of NSAIDs were supposed to cause less gastric problems. One of the big drawbacks of NSAIDs has always been the increased rate of gastrointestinal (GI) ulcer disease and bleeding. While the literature has supported the claim that these drugs cause fewer GI issues, other problems have surfaced. The problem that has grabbed the most headlines is Vioxx and its alleged link to heart problems.

Nonetheless, NSAIDs are still a mainstay in the treatment of osteoarthritis. These drugs decrease inflammation and pain. In the case of aspirin, ibuprofen and naproxen, they are often taken as an over-the-counter medicine or prescribed by a physician in larger doses.

While all the various NSAIDs have similar mechanisms of action, different people respond differently to various drugs. Your physician may try a number of different NSAIDs before deciding which one is best for you.

NSAIDs are also used extensively after an injury. In this setting I prefer to hold off using NSAIDs for the first 24 to 48 hours. That's because these drugs can cause some increased bleeding and might actually contribute to swelling in the acute setting.

The side effects of all NSAIDs are vast. The most common are bleeding, GI upset, swelling and fluid retention. In some cases, prolonged use can result in kidney problems. Long term use should definitely be monitored by your physician.

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Written by orthopedic surgeon and Masters sprinter Allan Tissenbaum, M.D., GeezerJock Doc is a forum for your questions about injuries, exercise and getting older. Submit questions to geezerjockdoc@geezerjock.com or mail to GeezerJock Doc, 2033 W. Hutchinson St., Chicago, IL 60618.