The effect of nonsteroidal anti-inflammatory drugs on tissue healing

Abstract

Purpose Non‐selective (NSAIDs) and selective (COX‐2) nonsteroidal anti‐inflammatory drugs are commonly used for their analgesic and anti‐inflammatory effects. Their role after orthopaedic surgery has been infrequently described and remains controversial because of unclear effects on soft tissue and bone healing. This study critically reviews the available literature to describe the effects of NSAIDs and COX‐2 inhibitors on soft tissue and bone healing. Methods A Medline search was performed using NSAIDs or COX‐2 inhibitors and tissue healing. The combined search yielded 637 articles. Following exclusion, 44 articles were deemed relevant with 9 articles on soft tissue healing and 35 articles on bone healing. The available evidence is based primarily on animal data (39 studies), with considerable variation in study methods. Results In regard to soft tissue healing, there is insufficient evidence of a detrimental effect when using either NSAIDs or COX‐2 inhibitors at standard doses for ≤2 weeks. For soft tissue to bone healing, a limited number of studies demonstrate impairment in healing. However, with respect to bone healing, indomethacin appears to have a clear detrimental effect, with less substantial evidence for other NSAIDs. Conclusions Short‐term, low‐dose use of NSAIDs and COX‐2 inhibitors does not appear to have a detrimental effect following soft tissue injury, but is inhibitory in cases involving bony healing. However, additional well‐controlled human studies are necessary to draw more definitive conclusions regarding their role. Clinically, the prudent use of anti‐inflammatory medications following sports medicine injuries and surgeries appears to be a reasonable option in clinical practice unless bone healing is required. Level of evidence III.

Side effects of pain and analgesia in animal experimentation

“…Results of animal studies examining tendon and ligament healing are contradictory 63 . In rats, for example, systemic use of diclofenac has an anti-proliferative effect, but has no effect on clinical wound healing 64 , whereas the postoperative use of NSAIDs can decrease the strength of anastomotic tissue and increase the risk of anastomotic leakage 65 .…”

Celecoxib 2% Cream in Acute Soft Tissue Injuries: Randomized, Double-blind, Placebo-controlled Clinical Trial

“…The prostaglandin pathway is primarily responsible for the release of mediators of inflammation so the treatment is focused on the inhibition of Cyclooxygenase (COX); thus Nonsteroidal AntiInflammatory Drugs (NSAIDs) block the COX-1 and COX-2 isoforms, and Celecoxib exclusively COX-2 [4]. Both groups are ideal for controlling sports injuries because they decrease excessive inflammation and pain [5].…”

Abordaje del dolor agudo en traumatología

“…En modelos animales, los AINE parecen provocar un retraso en la consolidación de las fracturas, sin embargo, estudios retrospectivos en humanos no han podido demostrar esta relación, a pesar de lo cual se recomienda un uso racional (69,70). Tampoco se ha podido demostrar un efecto negativo de los AINE en la reparación de tejidos blandos humanos (71).…”