Impact of NSAIDs on Tissue Healing
NSAIDs and Tissue Healing: What Patients Should Know About Pain Relief and Recovery
Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most commonly used medications for pain and inflammation. From sprained ankles to post-surgical discomfort, many patients rely on NSAIDs like ibuprofen, diclofenac, and celecoxib to feel better fast. However, while these medications can provide short-term relief, they may also interfere with the body’s natural healing processes, particularly in the context of bone and cartilage repair.
As physical therapists committed to your recovery and long-term wellness, we believe patients and families must understand how NSAIDs work, what risks they may pose, and when it might be wise to consider alternative strategies.
How NSAIDs Work
NSAIDs relieve pain and reduce inflammation by blocking enzymes called cyclooxygenases (COX-1 and COX-2). These enzymes help produce prostaglandins, chemicals involved in pain signaling, inflammation, and tissue repair. When prostaglandin production is blocked, inflammation and pain go down. But so does the body’s ability to regenerate tissue after injury.
Key Concerns About NSAID Use During Healing
🦴 Bone Healing
Multiple studies show a strong link between NSAID use and delayed bone healing or even nonunion (when a bone doesn’t heal properly). One study of over 1,900 patients found that taking NSAIDs after surgery doubled the risk of healing complications after long bone fractures.
Another large database study found that people who used NSAIDs in the year leading up to a fracture were more than twice as likely to experience healing problems. These findings suggest that NSAIDs may interfere with the very biological processes bones rely on to repair themselves.
🧬 Cartilage Repair
Cartilage, the smooth surface on the ends of joints, heals differently than bone, and evidence is growing that NSAIDs can also hinder cartilage repair. While mature cartilage cells (chondrocytes) may not be harmed, new cartilage formation appears to suffer.
For example, in laboratory studies, NSAIDs like diclofenac and ketorolac reduced the production of key cartilage components by nearly 50%. This may impact patients undergoing procedures such as microfracture or cartilage grafting, where the growth of new cartilage is crucial.
Other Healing Concerns
NSAIDs may also interfere with muscle and tendon repair. In animal studies, tendon injuries treated with NSAIDs exhibited weaker tensile strength and smaller tissue size, indicating that the tissue didn't heal as effectively. In some human studies, NSAID-treated patients had more swelling (edema) after ankle sprains, despite reporting better pain control.
Common Side Effects to Be Aware Of
NSAIDs are also well known for their impact on the gastrointestinal (GI) tract, which can include:
Heartburn and indigestion
Ulcers
GI bleeding (in severe cases)
These side effects occur because NSAIDs also damage the protective lining of the stomach and intestines, making them more vulnerable. Even newer "COX-2 selective" NSAIDs, designed to be gentler on the stomach, can still carry risks, especially with long-term use.
Weighing the Risks and Benefits
Not everyone who takes NSAIDs will experience healing complications. Factors like age, smoking history, diabetes, and the type of injury also play a role. But research shows that NSAID use, especially around the time of injury or surgery, can add to the risk, and physical therapists and physicians must weigh these factors carefully.
📝 Did you know? People with Type 1 or Type 2 diabetes were also found to have over 2 times the risk of fracture healing complications, similar to the increased risk seen with NSAID use.
What You Can Do
Talk to your healthcare provider before starting NSAIDs, especially if you’ve had a recent fracture, tendon injury, or joint surgery.
Explore alternative pain relief options, such as acetaminophen, physical therapy modalities (like ice, manual therapy, or TENS), and activity modifications.
Stay informed about your medications. Even over-the-counter NSAIDs can affect healing.
Ask about timing. In some cases, short-term use of NSAIDs might be appropriate, while more extended use should be avoided.
The Bottom Line
NSAIDs can be valuable tools for managing pain, but when it comes to healing bones, cartilage, or soft tissue, they may come at a cost. As physical therapists, we focus not just on short-term symptom relief but on supporting your body’s full recovery.
Before reaching for NSAIDs after an injury or surgery, have a conversation with your care team. Together, we can find a strategy that supports both comfort and long-term healing.