Chapter 3: Anti-inflammatory Medications

Chapter Objectives

Athletic trainers administer therapeutic modalities such as ultrasound, ice, and electrical stimulation on a daily basis. The goal of treatment is to bring about a rapid and complete resolution of injuries in order to expeditiously return athletes to competition. The treatment for each injury is typically devised and agreed on by the athletic trainer and the team physician, with each drawing on his or her past experience and knowledge of the current literature to develop the most beneficial rehabilitation plan. In recent years, that treatment plan has increasingly (and often reflexively) included prescription or over-the-counter (OTC) nonsteroidal anti-inflammatory medications (NSAIDs).

Electrical modalities, ultrasound, ice, heat, and therapeutic exercise all have accepted and valued roles in the rehabilitation of musculoskeletal injuries. Athletic trainers use these modalities regularly and are usually well aware of their effects, benefits, indications, and contraindications. However, the role of anti-inflammatory medications such as corticosteroids and NSAIDs in the rehabilitation process is not well defined or thoroughly understood.

The use of NSAIDs for the treatment of sports-related injuries, as well as other complaints (particularly osteoarthritis), continues to rise. In 2001, sales of NSAID prescriptions reached $10.9 billion in the United States alone.⁴⁷ This figure does not include sales of OTC drugs such as aspirin, ibuprofen, naproxen sodium, and ketoprofen. (Aspirin is technically an NSAID, but is not included in the generic term, which describes the newer agents.) It was recently estimated that more than 1 percent of the US population uses NSAIDs (other than aspirin) daily.⁶²

Although NSAIDs are considered relatively safe medications, such widespread use means that a significant number of individuals who take them are unable to tolerate certain side effects. Although gastrointestinal (GI) toxicity has been estimated to occur in only about 2 cases per 10,000 NSAID prescriptions dispensed,³⁴ this extrapolates to the rather startling figure of 14,000 yearly cases of serious GI complications, based on the over 70 million NSAID prescriptions filled in 1991.⁶ Such complications have led to the continued search for "safer" agents such as the cyclooxygenase-2(COX-2) inhibitors that have been introduced in recent years.

Considering that athletic trainers cannot prescribe or dispense prescription or OTC medications, why is this an important topic?¹⁰¹ If the athletic trainer understands the actions, indications, and side effects of corticosteroid and NSAID use, he or she can continue to play a pivotal role in all aspects of an athlete's treatment and rehabilitation plan. A thorough understanding of drug actions, interactions, and effects also enables the athletic trainer to educate athletes ...