A newer type of NSAID available is known as the COX-2 inhibitor. COX-2 inhibitors provide the anti-inflammatory effects of blocking the COX-2 enzyme, but do not affect the COX-1 enzyme, reducing the risk of stomach or intestinal damage. COX-2 inhibitors are ideal for patients who are considered to be at an elevated risk for developing stomach or intestinal problems; however, COX-2 inhibitors can increase the risk for damage to the heart, and thus, are not ideal for patients with problems with circulation or other types of heart conditions.
At every step of the analgesic ladder non-opioid analgesics form the basis of pain management. As long as they are not contraindicated, paracetamol, aspirin or an NSAID should also be prescribed with opioid analgesia (weak or strong). This is the concept that pain is best managed not by a single drug or therapy, but in combinations which maximise efficacy whilst keeping side-effects low. Research has demonstrated that when this happens, the synergistic effect on pain relief is improved, smaller amounts of pain killers are required and less side effects occur.
However, it should be remembered that the inflammatory or 'lag phase' is the first stage of the healing process and a degree of pain and loss of function may be helpful to prevent the athlete doing further damage to the injured part. The question of whether NSAIDs have an adverse effect on healing was examined by Obremsky et al (1994) and Almekinders (1986). Both studies showed no significant effect on tensile strength recovery following NSAID treatment for muscle strain injury, and Obremsky et al (1994) further demonstrated that muscular force was also unaltered. However, both studies showed histologic evidence of delayed healing with NSAID use, although it should be stated that both studies utilised animal models.