The Low-Down on NSAIDS

Guest Blog: Nancy Shura-Dervin

“I was popping vitamin I like they were M&Ms”… said one ultra runner recently.

NSAIDS: THE SHORT STORY…

If you have done much reading about ultra running, you are aware of the controversy surrounding the use of NSAIDs (non-steroidal anti-inflammatory drugs) during ultra marathon training and racing. Categorically, NSAIDS are drugs that may be OTC (over-the-counter) or prescription strength, are pain relievers, fever reducers. NSAIDs are particularly effective for treatment of mild-to-moderate pain due to inflammation associated with tissue injury. Common OTC NSAIDs are aspirin, ibuprofen, Advil and Aleve.

The most frequent side effect of NSAID use is dyspepsia aka stomach upset. GI (gastrointestinal) complications associated with NSAID use include stomach cramps, nausea, vomiting, heartburn, diarrhea, gastric ulcer and GI bleeding. Some NSAIDS are associated with increased risk of heart attack, heart failure and stroke.

Prostaglandins are hormones produced in the body in response to inflammation and tissue injury. NSAIDs are anti-prostaglandin by nature. By reducing levels of prostaglandin in the bloodstream, pain levels are decreased but negative effects may result in the kidneys where prostaglandin plays a vital role in kidney profusion (blood flow). Low prostaglandin levels may result in constriction of renal (kidney) blood flow. This constriction of renal blood flow combined with other stresses associated with endurance running (dehydration, electrolyte imbalance, adrenal fatigue, hyperthermia, muscle damage), are associated with increased incidence of acute renal failure, secondary to rhabdomyolysis (a condition in which damaged muscle particles are released into the blood stream). In recent years, there have been numerous documented cases of hospitalizations due to acute renal failure among ultra runners who have used NSAIDS during training and racing.

The Low Down…

Not only are NSAIDS a health risk for ultra runners, they actually interfere with our natural ability to manage pain. Here’s how it works…

You run, run, run. It starts to hurt. You have no real “fear” of this pain because your brain knows that it is normal to hurt when you are running such high mileage. As you continue to run, endorphins begin to flow through your bloodstream. According to Wikopedia, endorphins “are produced by the pituitary gland and the hypothalamus in vertebrates during exercise, excitement, pain, consumption of spicy food, love and orgasm, and they resemble the opiates in their abilities to produce analgesia and a feeling of well-being”. The more you train and train, the more adept you become at pumping out endorphins. Endorphins are endogenous morphine to an ultra runner and most likely are the reason that ultra running becomes so addictive to many. The constant flow of prostaglandins and endorphins throughout the running activity causes pain levels to ebb and flow and to become more manageable to the athlete as conditioning improves. But when NSAIDs are added to the mix, the body never becomes efficient at producing endorphins because the NSAIDs mask the natural response by artificially bring the pain level down. The problems with this are that (1) the pain levels eventually come back up again when the medication wears off, (2) NSAIDS create dependency so that higher and higher doses are required to relieve pain, (3) Pain levels increase through the cycle because the endorphin response has been blocked by the NSAID use, and (4) Side effects of NSAIDs begin to set in causing increasing risk to the runner.

Go Cold Turkey

The solution to the NSAID dilemma is to get clean, cold turkey! Teach yourself to train and run without using NSAIDs or pain relieving drugs at all. When you encounter discomfort, pain, or fatigue (and you will), tell yourself “this is normal”. Tell yourself “the more you hurt now, the less you hurt later”. Listen to your body and slow your pace or shorten your mileage a bit; pain is after all, a message from your body telling you to ease up! Each time you return to the trail, you will come back stronger. To deal with post run pain, elevate your legs, take a jacuzzi bath or ice bath, apply arnica Montana gel, get a nice recovery massage. As you train and run without NSAIDS you will find that your body becomes more adept at managing the pain and you won’t suffer the medical problems associated with NSAID use.

Anecdote…

In 2003, I had been training and racing ultra marathons for several years without using NSAIDS at all. At mile 110-ish of the Badwater 135-Mile Ultra Marathon, I was almost disabled by a sharp pain that felt like a hot knife was stabbing the back of my neck. This went on for several hours before finally becoming a “10” on the 1-10 pain scale. One of my crew asked me when I last took ibuprofen and I answered “six years ago”! After a good laugh, they popped a single Vitamin I in my mouth and within an hour, the pain was entirely gone!