Are OTC Painkillers Safe?
How Pain Meds Work
Ibuprofen eases pain by interfering with the body's production of prostaglandins, substances involved in inflammation. Normally, blocking prostaglandins isn't a problem. But because they cause blood vessels to dilate, which, in turn, increases blood flow to the kidneys, decreasing prostaglandins' effectiveness can slow kidney function. At the same time, strenuous exercise makes the body release proteins called myoglobins, which help build muscle but also weaken the kidneys. Without prostaglandins to increase blood flow, the kidneys may shut down.
Potential OTC pain reliever dangers were highlighted by a 2006 study of ultramarathoners competing in a 100-mile race through the Sierra Nevada. Seven in 10 participants took ibuprofen before or during the race. Runners taking the maximum daily dosage (six 200-milligram tablets) had a 50 percent higher rate of inflammation than those who didn't, and they also suffered from weakened kidney function, researchers found. "Not only was the ibuprofen ineffective, but it had the opposite of the desired effect," says lead study author David Nieman, DrPH, an exercise physiologist and the director of the Human Performance Laboratory at the North Carolina Research Campus in Boone. "Essentially, it promoted inflammation and impaired kidney function."
Despite these concerns, OTC pain meds can still be a valuable tool for exercise recovery, provided you use them as directed. Which one you should choose depends on your symptoms. In most cases, the safest option for simple relief (sore hamstrings, for example) is acetaminophen because it has the fewest side effects, says Robert Sallis, MD, codirector of the Sports Medicine Fellowship at Kaiser Permanente Medical Center in Fontana, California. (Avoid drinking while you're taking it, since alcohol increases the drug's toxicity.) For temporary relief of swelling, redness, and joint-related inflammation (due to, say, a minor sprain), go with an NSAID (ibuprofen or naproxen).
If your aches are chronic, you should consult a doctor. But until then, consider cutting your OTC dose in half, knowing that you may take the meds more often than someone with a one-off injury. "I take half a dose of Aleve before I go to bed if I feel any pain," says Jennifer Mounce, a 39-year-old San Francisco-based executive coach who works out at least five times a week. Her enthusiasm for Spinning classes, yoga, and free weights frequently leaves her achy, so she checked with her doctor about the right course of treatment. "Although it is OTC, it's still a pretty powerful drug, and I take it frequently -- maybe two to three times a week," she says. "I wanted to be sure it was safe."
Even if you take a reduced dose, cross-check the label with those of any other meds you may be taking. Over-the-counter remedies for colds, flus, coughs, and other everyday ailments frequently contain acetaminophen or ibuprofen already. "About 50 percent of the overdoses are inadvertent," Dr. Lee says. "People take pills for pain and then add in other medications such as NyQuil or Tylenol PM to go to sleep."
Some experts, though not all, feel that acetaminophen and ibuprofen can be used in combination without causing any serious adverse side effects because they take different pathways of action. But if you require several meds to keep pain in check, it could be a warning sign that you're overdoing it on exercise or have damaged tissue, Dr. Engle says. Rather than taking pills every few hours, talk with your physician.
Also, although the maximum FDA-recommended daily intake of acetaminophen is 4,000 milligrams (the equivalent of eight 500 milligram extra-strength pills taken two at a time over 24 hours), "athletes should limit their daily intake to no more than 2,000 milligrams," Dr. Sallis says. "It's a conservative dose, but it makes sense because of the added stress the liver and other organs already undergo during vigorous exercise."
Ultimately the best remedy to take to recover from a tough workout may not come in a bottle at all. Icing muscles at least 15 minutes immediately following intense exercise may ease inflammation and minimize pain more effectively than medicine. Massage, hot baths, and gentle walking or jogging (known as active recovery) the following day can help as well. "For people who've been exercising heavily, nonpharmaceutical methods are more beneficial than anything else," Warden says.
After years of dealing with the aches that came from pursuing her fitness passion, Meredith Castelli finally realized the best way to treat her exercise-induced pain was...with more exercise. The 38-year-old fitness instructor from Gainesville, Virginia, hits the gym five times a week, lifting weights and working up a sweat on the treadmill or elliptical machine. "I take OTC pain meds only as a last resort," Meredith says. "If I get sore, I'll walk the next day and do a lot of stretching, which boosts blood flow to aching muscles. Over the years, I've found it's the fastest way to recover and get back in the game."
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