Ibuprofen and paracetamol!

If you are unfortunate enough to have an injury and you want to use OTC (over the counter) medicine, which is best?

I must first express that I use neither of these remedies. I don't tend to carry injuries and if I do I modify my training and nutrition accordingly. I've stated before that I am not a huge believer or prescriber of mechanical strain causing pain. However here's what you can expect from these two products.

How does Ibuprofen work?

Ibuprofen is commonly known as an NSAID's (non steroidal anti inflammatory drugs), what that means is this drug will combat inflammation at the source. 

Example: if while out running you trip and twist you ankle joint causing some minor connective tissue damage which presents as tender, hot, red and painful. You can be sure you have an inflammation. The inflammatory process starts off with a release of histamine from the injured tissue cells. This last about 15 seconds, after which the cells have to produce another substance to keep the inflammatory process going. Remember we need the inflammatory process because it is the beginning of the repair process. 

Once the histamine has been released, the same cells use COX1 & COX2 enzymes present in the blood to manufacture prostaglandins. Without these two COX (Cyclooxygenase) enzymes the cells can not make prostaglandins and therefore the inflammatory process is halted. The ibuprofen or anti inflammatory drugs denature the COX enzymes in the blood which means these cells can not prolong the inflammation and you recover sooner. Our bodies are programmed to produce about 10 times more inflammation than required, but rest assure inflammation is very very useful and with out it you would never heal. 

So if ibuprofen can denature COX enzymes, why not give everybody a small does every day and minimise overall tissue damage?

Just like all things in physiology you can not mess with one system without messing with another. Let me explain. Our stomachs are a dark vat of hydrochloric acid. The substance we use to stop this acid digesting the stomach wall is called intrinsic factor. Intrinsic factor is manufactured by parietal cells, the key ingredient used to make intrinsic factor are COX enzymes. 

Most people on long term NSAID's should be also taking omeprazole, which will reduce the hydrochloric acid in the stomach. This, it is thought will make up for the lack of intrinsic factor but low hydrochloric acid will cause many digestion and reflux problems. So personally I think it's best to avoid these nasty pitfalls.

Note; low intrinsic factor levels will cause pernicious anaemia another pitfall of trying to manipulate one aspect of physiology. Anaemia deserves a whole separate post!

So ibuprofen will have an impact on the actual site and it will help with the recovery process. It's worthy to point out that once the inflammation is inhibited some of the pain will be inhibited too. So there are some analgesic affects of taking NSAID's. 

How does paracetamol work?

If we take from the above that NSAID's actually have a direct impact on the tissues involved and that they can help the healing process (although its at the detriment of your health), we can take from this that paracetamol (pain killers) will not. 

These work to kill the pain, usually quite effectively for about 3 hours but they will not impact the site and they will not promote healing. They work by blocking a receptor on your brain. All feeling (sensory input) makes its way to the brain by 3 cables (neurones). When you want to block a pain message jumping across the final cable to the point on the brain that registers pain you can pop a few paracetamol. They fill the receptor sites so the pain message can not complete it's journey, making you unaware of the pain until they are worn out. Once they ware off the pain will return until your body manages to control the inflammation itself. This usually takes about 48 hours. Although you can help this process using alternative methods. 

What's the alternative approach?

Ice the area of inflammation ASAP. Remember the prostaglandins will start to be produced 15 seconds after injury and will continue for about 48 hours. Icing the area will cause the blood vessels to constrict, taking blood away. Less blood means less COX enzymes and therefore less prostaglandins so less inflammation, which we now know means less pain. 

Increase anti-inflammatory foods over these 48 hours. Any raw fruit or vegetables will benefit this process. But specifically  

Bioflavonoids in citrus fruits and berries
Mint, Cumin, Thyme and Paprika
Cherries and Cherry juice
And let's not forget mushrooms and Green leafy veg!

Try to avoid chicken and eggs. Poultry products are the greatest cause of a pro inflammatory state in the body.

Both of these drugs are a common feature on ultra distance aid stations and on long training runs. It should be noted that apart from the effects stated above NSAID's are likely to yield some kidney damage if taken during endurance sports and you body is likely to be dehydrated. Also pain killers like paracetamol may cause some liver dysfunction if you pop too many during times of prolonged exercise and low body hydration.

Neil
@RunSensible