Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes [Should athletic injuries be treated with non-steroidal anti-rheumatic agents (NSAID)? Tenoxicam, piroxicam and placebo in the treatment of acute stress-induced injuries]. Do non-steroidal anti-inflammatory drugs have a significant effect on detection and grading of ultrasound-detected synovitis in patients with rheumatoid arthritis? Results from a randomised study Effectiveness of topical non-steroidal anti-inflammatory drugs in the management of breast pain. [Efficacy of percutaneous administration of anti-inflammatory drugs in swimmers and water-polo players]. Extended results of the Alzheimer’s disease anti-inflammatory prevention trial Association of chronic non-steroidal anti-inflammatory drugs use and cognitive decline in non-demented elderly patients admitted to a geriatric evaluation and rehabilitation unit. Comparison of nonsteroidal anti-inflammatory drugs, ibuprofen and flurbiprofen, with methylprednisolone and placebo for acute pain, swelling, and trismus. Effect of non-steroidal anti-inflammatory drugs on radiographic spinal progression in patients with axial spondyloarthritis: results from the German Spondyloarthritis Inception Cohort Characteristics of subjects experiencing hypersensitivity to non‐steroidal anti‐inflammatory drugs: patterns of response Are non-steroidal anti-inflammatory drugs effective for the management of neck pain and associated disorders, whiplash-associated disorders, or non-specific low back pain? A systematic review of systematic reviews by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration Evaluation of the nonsteroidal anti-inflammatory drug-sparing effect of etanercept in axial spondyloarthritis: results of the multicenter, randomized, double-blind, placebo-controlled SPARSE study A group randomized trial to improve safe use of nonsteroidal anti-inflammatory drugs. Comparative efficacy and safety of the non-steroidal anti-inflammatory drugs nimesulide and diclofenac in patients with acute subdeltoid bursitis and bicipital tendinitis. Nonsteroidal anti-inflammatory drug use and acute myocardial infarction. Nonsteroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. A study of manufacturer-supported trials of nonsteroidal anti-inflammatory drugs in the treatment of arthritis.
Superstitions and rituals are commonplace in sports and range from simple activities such as each player touching a special inanimate object before entering the field of play to more extreme behaviours such as not washing a uniform or wearing the same underwear during a winning streak . These practice s are relatively harmless and may reduce precompetition anxiety , but a concerning ritual that has recently developed in sports is the prophylactic use of non-steroidal anti-inflammatory drugs ( NSAIDs ) . Athletes have relatively unrestricted access to NSAIDs , as they are readily available over-the-counter preparations and not considered as performance-enhancing drugs by the World Anti-Doping Agency.1 It has been known for some years that athletes are frequent users of NSAIDS,2 with approximately a quarter of athletes competing at the Sydney 2000 Olympic Games reporting NSAID use in the 3 days before r and om drug testing.3 Such prevalent NSAID use may reflect the physical rigors of elite athletic endeavours , but more recent data suggest athletes misuse their open access to NSAIDs . Tscholl and colleagues4 recently reported in this journal that 23 % of top-level male football players  used NSAIDs  in two out of three matches during the 2002 and 2006 A total of 212 patients with acute sports injuries were allotted at r and om to treatment with 20 mg tenoxicam daily , 20 piroxicam daily or a placebo for ten days . The injuries could be subdivided into six groups : Tendinitis , periostitis , sprains , tendovaginitis , epicondylitis and muscular ruptures . Treatment was well tolerated and analysis of the total material showed a slight but significantly better effect in the group treated with the active drugs . More detailed analysis revealed that this increased effect was produced by a definitely better therapeutic result in the group of patients with tendinitis treated with non-steroid anti-inflammatory drugs ( NSAID ) while , in the other types of injury , no definite effect could be observed . On the basis of these observations , the authors conclude that acute tendinitis may be treated with NSAID ( tenoxicam ) while the question is not yet solved where other acute stress-induced injuries are concerned Objectives To determine whether non-steroidal anti-inflammatory drugs ( NSAIDs ) have a significant effect on ultrasonographic ( US ) grey scale ( GS ) and power Doppler ( PD ) assessment of synovitis in rheumatoid arthritis ( RA ) . Methods Patients with RA taking NSAIDs were r and omised to either stopping ( for a minimum of 5 drug half-lives ) or continuing the drug . All patients had a clinical assessment and US examination of both h and s and wrists before and after stopping/continuing the NSAID . Changes at follow-up were compared between groups using Mann – Whitney U tests . Results A total of 58 patients with RA were recruited . All the clinical assessment parameters ( including disease activity , pain , general state of health and physician global visual analogue score and tender and swollen joints count ) showed an increase in the group who stopped their NSAID treatment . The total GS and PD score showed median ( first to third quartiles ) increase of 9.5 ( 5.75 to 19.0 ) and 4.0 ( 2.0 to 6.0 ) per patient , respectively , in the patients who stopped their NSAID in comparison with 1.0 ( –1.0 to 2.25 ) and 0.0 ( –2.0 to 3.0 ) , respectively , in the patients who continued their NSAID ( p<0.001 ) . There was an increase in the number of joints scoring > 0 for GS and PD in the patients who stopped the NSAID . The inter- and intrareader agreement was good to excellent for the US examination . Conclusion NSAID usage may mask the GS and PD signal and result in lower scoring despite continuing disease activity . Consideration should be given to the NSAID effect in design ing clinical studies which use US to assess response to therapeutic A prospect i ve study of the effectiveness of the topical application of non-steroidal anti-inflammatory drugs ( NSAIDs ) as a gel preparation was carried out in 26 women with severe breast pain . The results showed a satisfactory relief of pain in 81 % of the women : 11 of 13 with cyclical pain , eight of 11 with non-cyclical pain , and in two women with severe scar pain after lumpectomy and radiotherapy .  Topical NSAID gel was applied as required ; the relief of severe pain was rapid and no side effects were reported . These factors compare favourably with established recommended treatments which usually involve months of continuous treatment , tailoring of drug dosages and a significant incidence of intolerable side effects . This study has shown that topical NSAID application is an effective , safe , acceptable and easily administered treatment for severe cyclical and non-cyclical breast pain It can be concluded from the research reported above that diclofenac diethylammonium ( NSAID ) in cases of professional swimmers and waterpolo players who have either an ache or suffered a severe hit , when applied externally offers rapid and excellent results Epidemiologic evidence suggests that nonsteroidal anti‐inflammatory drugs ( NSAIDs ) delay onset of Alzheimer 's dementia ( AD ) , but r and omized trials show no benefit from NSAIDs in patients with symptomatic AD . The Alzheimer 's Disease Anti‐inflammatory Prevention Trial ( ADAPT ) r and omized 2528 elderly persons to naproxen or celecoxib versus placebo for 2 years ( st and ard deviation = 11 months ) before treatments were terminated . During the treatment interval , 32 cases of AD revealed increased rates in both NSAID‐assigned groups In a geriatric evaluation and rehabilitation unit ( GERU ) , 258 elderly patients ( M : 71 , F : 187 ; mean age 77.4 + /- 7.5 ) scoring 22 or more at Mini-Mental State Examination ( MMSE ) consecutively admitted were assessed in order to evaluate the effects of non-steroidal anti-inflammatory drugs ( NSAID ) chronic treatment on cognitive status in non-demented elderly patients . Sixty-six patients ( 25.6 % ) were considered chronic NSAID users . Patients chronically assuming NSAADs showed a significantly higher MMSE score than non-users ( 26.9+/-2.1 vs 25.7+/-2.5 , P<0.0005 ) . After controlling for potential confounders in a multivariate model , chronic NSAID use remained independently associated with MMSE score . The results support a positive association between chronic NSAID use and cognitive function in non-demented elderly patients . R and omized controlled trials will be needed to definitively prove this beneficial effect Pain , swelling , loss of function , and hyperthermia are acute postoperative sequelae of inflammation due to tissue injury during surgical procedures . Pharmacologic strategies for minimizing the clinical manifestations of surgical trauma are often directed toward blocking the formation or inhibiting the effects of the biochemical mediators of acute inflammation . This study compared two nonsteroidal anti-inflammatory drugs ( NSAIDs ) , flurbiprofen and ibuprofen , with a prototype glucocorticoid , methylprednisolone , in two replicate placebo-controlled studies for suppression of inflammation due to the surgical removal of impacted third molars . The results indicate that NSAIDs produce greater initial analgesia than do steroids , whereas steroids result in greater suppression of swelling and less loss of function . Examination of the pooled data from the two studies indicates that NSAID pretreatment results in a modest suppression of swelling in comparison with placebo . These data suggest that the acute analgesic effects of NSAIDs in the oral surgery model are due to suppression of a nociceptive process , presumably prostagl and in formation , rather than a generalized anti-inflammatory effect Objective To investigate the influence of non-steroidal anti-inflammatory drugs ( NSAIDs ) intake on radiographic spinal progression over 2 years in patients with ankylosing spondylitis ( AS ) and non-radiographic axial spondyloarthritis ( SpA ) . Methods 164 patients with axial SpA ( 88 with AS and 76 with non-radiographic axial SpA ) were selected for this analysis based on availability of spinal radiographs at baseline and after 2 years of follow-up and the data on NSAIDs intake . Spinal radiographs  were scored by two trained readers in a concealed r and omly selected order according to the modified Stoke Ankylosing Spondylitis Spine Score ( mSASSS ) system . An index of the NSAID intake counting both dose and duration of drug intake was calculated . Results High NSAIDs intake ( NSAID index≥50 ) in AS was associated with lower likelihood of significant radiographic progression defined as an mSASSS worsening by ≥2 units : OR=0.15 , 95 % CI 0.02 to 0.96 , p=0.045 ( adjusted for baseline structural damage , elevated C reactive protein ( CRP ) and smoking status ) in comparison with patients with low NSAIDs intake ( NSAID index<50 ) . This effect was most pronounced in patients with baseline syndesmophytes plus elevated CRP : mean mSASSS progression was 4.36±4.53 in patients with low NSAIDs intake versus 0.14±1.80 with high intake , p=0.02 . In non-radiographic axial SpA , no significant differences regarding radiographic progression between patients with high and low NSAIDs intake were found . Conclusion A high NSAIDs intake over 2 years is associated with retarded radiographic spinal progression in AS . In non-radiographic axial SpA this effect is less evident , probably due to a low grade of new bone formation in the spine at this stage Background Non‐steroidal anti‐inflammatory drugs ( NSAIDs ) are one of the most frequently involved groups of medicines in hypersensitivity drug reactions . Two mechanisms can induce the reaction : immunological ( sensitization ) due to a specific IgE or T cell response and pharmacological ( cyclooxygenase inhibition ) . The contribution of each of these mechanisms to the reactions is not well known Abstract Purpose To evaluate the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) for the management of neck pain and associated disorders ( NAD ) , whiplash-associated disorders , and non-specific low back pain ( LBP ) with or without radiculopathy . Methods We systematic ally search ed six data bases from 2000 to 2014 . R and om pairs of independent review ers critically appraised eligible systematic review s using the Scottish Intercollegiate Guidelines Network criteria . We included systematic review s with a low risk of bias in our best evidence synthesis . Results We screened 706 citations and 14 systematic review s were eligible for critical appraisal . Eight systematic review s had a low risk of bias . For recent-onset NAD , evidence suggests that intramuscular NSAIDs lead to similar outcomes as combined manipulation and soft tissue therapy . For NAD ( duration not specified ) , oral NSAIDs may be more effective than placebo . For recent-onset LBP , evidence suggests that : ( 1 ) oral NSAIDs lead to similar outcomes to placebo or a muscle relaxant ; and ( 2 ) oral NSAIDs with bed rest lead to similar outcomes as placebo with bed rest . For persistent LBP , evidence suggests that : ( 1 ) oral NSAIDs are more effective than placebo ; and ( 2 ) oral NSAIDs may be more effective than acetaminophen . For recent-onset LBP with radiculopathy , there is inconsistent evidence on the effectiveness of oral NSAIDs versus placebo . Finally , different oral NSAIDs lead to similar outcomes for neck and LBP with or without radiculopathy . Conclusions For NAD , oral NSAIDs may be more effective than placebo . Oral NSAIDs are more effective than placebo for persistent LBP , but not for recent-onset LBP . Different oral NSAIDs lead to similar outcomes for neck pain and LBP Introduction In clinical practice , nonsteroidal anti-inflammatory drugs ( NSAIDs ) are commonly discontinued after response to biologic therapy is achieved in patients with axial spondyloarthritis ( axSpA ) , but the impact of NSAID discontinuation has not been assessed in prospect i ve controlled trials . The aim of the SPARSE study was to evaluate the effects of the anti-tumor necrosis factor agent etanercept on NSAID intake and conventional clinical outcomes in axSpA patients . Methods In the double-blind , placebo-controlled period , patients with active ( mini Bath Ankylosing Spondylitis Disease Activity Index ( BASDAI ) ≥4 ) axSpA despite optimal NSAID intake were r and omized to receive etanercept 50 mg or placebo once weekly for 8 weeks . All patients were advised to taper/discontinue their NSAID intake during the treatment period . NSAID intake was self-reported by diary and Assessment of SpondyloArthritis International Society (ASAS)-NSAID scores calculated based on ASAS recommendations . The primary endpoint was change from baseline to week 8 in ASAS-NSAID score ( analysis of covariance ) . Results In 90 r and omized patients at baseline , mean age ( st and ard deviation ) was 38.9 ( 11.8 ) years ; disease duration , 5.7 ( 8.1 ) years ; 59/90 ( 66 % ) were human leukocyte antigen-B27 positive ; 51/90 ( 57 % ) had radiographic sacroiliitis ; and 45/90 ( 50 % ) were magnetic resonance imaging sacroiliitis-positive . Mean ASAS-NSAID scores were similar between etanercept and placebo groups at baseline ( 98.2 ( 39.0 ) versus 93.0 ( 23.4 ) ) , as were BASDAI ( 6.0 ( 1.7 ) versus 5.9 ( 1.5 ) ) , and Bath Ankylosing Spondylitis Functional Index ( 5.2 ( 2.1 ) versus 5.1 ( 2.2 ) ) . Mean changes ( SE ) in ASAS-NSAID score from baseline to week 8 were –63.9 ( 6.1 ) and –36.6 ( 5.9 ) in the etanercept and placebo groups ( between-group difference , –27.3 ; P = 0.002 ) . Significantly higher proportions of patients receiving etanercept versus placebo had an ASAS-NSAID score < 10 ( 46 % versus 17 % ; P = 0.008 ) and ASAS-NSAID score of 0 ( 41 % versus 14 % ; P = 0.013 ) at this time point . Significantly more patients in the etanercept versus placebo group achieved BASDAI50 ( 39 % versus 18 % ; P = 0.032 ) and ASAS40 ( 44 % versus 21 % ; P = 0.028 ) at week 8 . Conclusions In patients with axSpA , etanercept was associated with clinical ly relevant NSAID-sparing effects in addition to significant improvements in conventional clinical outcomes .Trial registration Clinical Trials.gov NCT01298531 . Registered 16 February 2011 OBJECTIVE To determine whether audit/feedback and educational material s improve adherence to recommendations for laboratory monitoring and cytoprotective agents to detect and prevent adverse events caused by nonsteroidal anti-inflammatory agents ( NSAIDs ) . STUDY DESIGN Controlled , cluster-r and omized trial . METHODS Physicians commonly prescribing NSAIDs  were identified within a large managed care organization and r and omized to a control or an intervention group ( audit/feedback with peer-derived benchmarks and continuing medical education ) . Medical records were examined 10 months before and after the intervention for clinical data and receipt of complete blood count ( CBC ) , creatinine testing , and cytoprotective agents ( process measures ) . Primary analysis compared intervention versus control physicians among those who initially performed below a peer-derived benchmark . General estimating equations accounted for patient clustering . RESULTS Of 101 physicians initially r and omized , 85 remained eligible ( 38 internists , 36 family physicians , 11 rheumatologists ) postintervention .  Mean percent change in performance between intervention and control physicians for CBC monitoring was 16 % versus 10 % ; for creatinine monitoring , 0 % versus 17 % ; and use of cytoprotective agents , -3 % versus -1 % . None of these changes were significant . Rheumatology specialty , number of NSAID prescriptions and physician visits , and patient risk factors for NSAID-related toxicity were more strongly associated with improved safety practice s than the intervention . CONCLUSIONS Audit/feedback and educational material s had no observed effect on improving NSAID-related safety practice s. Potentially contributing factors include high baseline performance ( ceiling effect ) , dilution of the intervention effect by case mix and provider factors , nonreceipt of intervention material s , and diverse indications for lab tests The efficacy and tolerability of nimesulide , a non-steroidal anti-inflammatory drug ( NSAID ) 100 mg twice daily were compared with diclofenac 75 mg b.i.d . in short term treatment of acute shoulder ( acute subdeltoid bursitis and bicipital tendinitis ) in adult patients . In this double-blind ( double-dummy ) , r and omised , parallel group study over two weeks , 122 patients were included . The Mann-Whitney statistics revealed therapeutic equivalence of both treatments with a slight superiority for nimesulide . The tolerability of nimesulide  , judged by investigators and patients and analysed statistically , was superior to that of diclofenac . Thus , the benefit-risk relationship was better for the test drug than for the reference drug BACKGROUND Although aspirin has been shown to protect patients from acute myocardial infa rct ion ( AMI ) , the effect of nonaspirin nonsteroidal anti-inflammatory drugs ( NSAIDs ) is not clear . OBJECTIVE To determine whether NSAIDs have a similar effect or whether they differ in their effect on the risk of AMI . METHODS We performed a case-control study of AMI in a large health care data base containing information on all filled prescriptions , hospitalizations , diagnoses , and procedures for all patients covered by the New Jersey Medicaid or Medicare and Pharmaceutical Assistance for the Aged and Disabled programs . We identified 4425 patients hospitalized for AMI between January 1 , 1991 , and December 31 , 1995 , and 17 700 control subjects . Multivariate models were constructed to control for potential confounders . RESULTS A quarter of the cases and controls had filled a prescription for an NSAID in the 6 months before theirAMI ( cases ) or a r and omly assigned index date ( controls ) ; 9 % had filled a prescription for an NSAID that overlapped with their date of AMI or index date . Overall , NSAID users had the same risk of AMI as nonusers , whether such use was measured on the index date ( adjusted odds ratio , 1.04 ; 95 % confidence interval , 0.92 - 1.18 ; P = .55 ) or at any time in the prior 6 months ( adjusted odds ratio , 1.00 ; 95 % confidence interval , 0.92 - 1.08 ; P = .92 ) . However , use of naproxen was associated with a significant reduction in the risk of AMI ( adjusted odds ratio , 0.84 ; 95 % confidence interval , 0.72 - 0.98 ; P = .03 ) . CONCLUSIONS Although NSAIDs have anti-inflammatory and antiplatelet effects similar to those of aspirin , we did not find that these drugs confer a protective effect against AMI . However , use of one specific NSAID , naproxen , appeared to be associated with a reduced rate of AMI , an effect recently suggested by a large r and omized controlled trial as well BACKGROUND Aging is associated with greater susceptibility to muscle injury and soreness after exercise . Although elderly persons regularly consume nonsteroidal anti-inflammatory drugs ( NSAIDs ) , it is not clear that NSAIDs alleviate muscle dysfunction and /or inflammation following injurious exercise . METHODS In this double-blind crossover study , 10 men and 5 women ( aged 60 + /- 2 years , mean + /- SE ) consumed naproxen sodium or placebo for 10 days after performing 64 unilateral eccentric ( ECC ) knee extensions using 75 % of the ECC 1-repetition maximum .  Strength was measured before , 3 days after , and 10 days after each bout . Injury and soreness were assessed using magnetic resonance images of m. quadriceps femoris ( QF ) and a visual analog scale . RESULTS Three days after exercise , concentric strength loss was greater for placebo ( -32 + /- 9 % ) than NSAID ( -6 + /- 8 % ; p = .0064 ) . Likewise , isometric strength declined less for NSAID than placebo ( -12 + /- 7 % vs -24 + /- 4 % ; p = .0213 ) , and thigh soreness while rising from a chair was greater for placebo ( p < or = .0393 ) than NSAID ( 43 + /- 7 mm vs 26 + /- 7 mm ) . QF cross-sectional area ( cm(2 ) ) showing elevated T(2 ) was 27 % and 35 % greater ( p < or = .0096 ) for placebo on Days 3 and 10 , respectively . CONCLUSIONS Naproxen sodium attenuated muscle injury , strength loss , and soreness following ECC exercise in older individuals and may be beneficial during the early stages of increased physical activity BACKGROUND To study the relation between reported drug performance in published trials and support of the trials by the manufacturer of the drug under evaluation , we studied a sample of trials of  nonsteroidal anti-inflammatory drugs ( NSAIDs ) used in the treatment of arthritis . METHODS All r and omized control trials of NSAIDs published between September 1987 and May 1990 identified by MEDLINE were review ed . If an article met the following criteria ( n = 61 ) , it was selected : trials involving adult patients with osteoarthritis or rheumatoid arthritis ( n = 180 ) , use of nonsalicylate NSAIDs marketed in the United States ( n = 101 ) , r and omized control trial ( n = 81 ) , duration of the trial 4 or more days ( n = 78 ) , and use of an efficacy outcome measure ( n = 61 ) . Review ers , " blinded " to manufacturer status , evaluated the narrative interpretation of results and extracted numeric data on efficacy and toxicity . Manufacturer-associated trials were defined as those that acknowledged an association with a pharmaceutical manufacturer . Because of the scarcity of non-manufacturer-associated trials ( n = 9 ) , we report only on the manufacturer-associated articles . RESULTS Fifty-two publications ( 85.2 % ) representing 56 trials were associated with a manufacturer . The manufacturer-associated drug was reported as comparable with ( 71.4 % ) or superior to ( 28.6 % ) the comparison drug in all 56 trials . These narrative cl aims of superiority were usually justified with trial data . Of the trials identifying one drug as less toxic ( n = 22 ) , the manufacturer-associated drug 's safety was reported as superior to the comparison drug in 86.4 % of cases . Justification for the narrative interpretation of the trial findings regarding less toxicity was provided in only 12 ( 54.5 % ) of 22 trials . CONCLUSION The manufacturer-associated NSAID is almost always reported as being equal or superior in efficacy and toxicity to the comparison drug . These cl aims of superiority , especially in regard to side effect profiles , are often not supported by trial data . These data raise concerns about selective publication or biased interpretation of results in manufacturer-associated trials
There was neither significant difference in the maximum performance between NSAIDs and control groups nor in the time until exhaustion nor in self-perceived pain .
Non-steroidal anti-inflammatory drugs ( NSAIDs ) are medications that are frequently used by athletes .
There may also be some abuse of these substances , although it is unclear whether NSAIDs in fact enhance performance .
We performed a systematic review and meta- analysis to evaluate the effect of NSAIDs on sport performance indices .