Here’s a question for knowledgeable people like @JTuori or @Brian. If you’re trying to determine if an injury is inflammatory or not, will taking an NSAID like ibuprofen make much of a difference? With my plantar fasciopathy, which is not inflammatory, taking ibuprofen doesn’t make any difference at all, which sort of makes sense.
@adamengst It depends on what we think the contributing drivers of the pain are- mechanical, chemical, psychological etc. This would be a good question for Dr. Getzin. Though it’s far from my area of specialty, I would think the analgesic aspect of the drug would be what helps with the pain, not the anti-inflammatory component (as most PFP cases we see are likely not inflammatory)
Andy’s not on the forum yet, unfortunately. Let’s see… maybe @karl-granroth knows more about the difference between the analgesic and anti-inflammatory aspects of the NSAIDs.
To be clear, I’m asking more from a diagnostic standpoint, as in, would the efficacy of NSAIDs help you decide if an injury is inflammatory or degenerative. I’m not generally a fan of reducing pain through artificial means, since at least acute (as opposed to chronic) pain exists to provide feedback to “stop doing that, stupid.” 
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From my understanding, technically yes a course of NSAIDS could be diagnostic. But there are many factors as Jason alluded to, so I wouldn’t treat a symptom reduction “from” NSAIDS as conclusive. And, there are other (better) ways to determine the best course of action that don’t involve disrupting the chemical “soup”, so even if it was a perfect test, I’d prefer less disruptive means.
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To be clear, you are asking “If an NSAID does not work on a particular injury/pain pattern, one can infer from that lack of efficacy that the injury/pain pattern is more a degenerative pattern rather than an inflammatory one??”
I can’t say that I would ever make that inference. At least not in a general sense. I may be confused though on the query.
That said, if say a plantar fascia problem continues to fail the usual course of ‘conservative’ care…icing, stretching, reduction in workload…continues to fail PT, orthotics, pain meds (regardless of type), and fails steroid injections, then I would be thinking degenerative, and talk about prolotherapy and it’s variations as an option prior the the knife. So in a way, I would start ruling out an inflammatory mechanism and thinking degenerative if a course of treatment is not effective, but I likely would not make that call just because an NSAID by itself didn’t seem to work.
As for acute pain implying that something is wrong and should be stopped, it’s not wrong, but it’s not always accurate. There are many cases where pain blocking is necessary for someone to carry out essential physical therapy when structural damage has been ruled out.
There is also the documented cases of elite athletes using pain meds…Opioids, Tramadol, Tylenol to block pain signals. This masking in most cases does not directly increase the risk for muscular damage, but likely modulates the pain signal and decreases the drive to throttle back. I realized as I wrote this, that I don’t think it relates…but maybe it just points out that there are a lot of athletes who’d rather tell their feedback to just ‘shut up!’
I’ll ask Monika if she leans a certain way when an NSAID fails, but I have a feeling, it’s no. Many clinicians I’ve worked with don’t worry too much about the local effects of the major two classes of OTC pain meds, and more the systemic, i.e. kidney and liver issues. There was a session at the American Medical Society of Sports Medicine conference (non surgical sports docs) a few years back where everyone fought over whether NSAIDS are good/bad in all of there ways, but I’ve forgotten much of it. Wait until someone pees after an ultra run before giving ibuprofren was something I do remember though…but I digress…
Monika, my MD, non-surgical sports medical wife, did say that the newest thoughts are that many sports docs are actually stopping prior to injecting with steroids and instead going to PRP earlier than in the past with the thinking that many are likely more degenerative. PRP is still cash-pay though as most insurance companies won’t cover it yet.
-Karl
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(Split this discussion off into its own topic to avoid confusing the patellofemeral pain topic…)
Thanks for the thoughts, everyone. It sounds like there could theoretically be a nugget of truth to the possibility that the failure of an NSAID might suggest a degenerative condition, but that there are so many confounding factors (not the least of which is taking the NSAID itself) that it’s not worthwhile.
I do want to make clear to everyone reading that the people commenting here who are medical professionals are speaking purely as friends and fellow runners. Do not take anything here as explicit medical advice! If you’re having a problem, for goodness sake, see a sports medicine doctor like Monika Radloff or Andy Getzin, or make an appointment with a physical therapist like Jason Tuori or Brian Lee or Andy Jordan. If nothing else, any professional has to examine you in person and hear your entire story before recommending specific treatment.
What I appreciate about this discussion is the opportunity to learn more from experts, even (or perhaps especially) if it means debunking something I’d been pondering. There’s a ton of information out there for injured runners, but so much of it is dubious or out-of-date that it can be difficult to know what to trust.
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