Better Living Through Chemistry?

Suzanne and I were on the west coast...of Michigan, last week, for our son's wedding.  We were changing into our fine attire and lacing up our tennis shoes - a 'fashion statement' if you're not a runner; otherwise it's another day in rubber soles - when Suzanne asked, "do you have any ibuprofen?"

"Well, no," was my reply. 

When Suzanne and I travel, the first thing/s packed are (one or more pairs of) running shoes, shorts, socks, t-shirts, and my Garmin 310XT.  Whatever space I have in my luggage after that goes to "civilian" clothes once the personal care items, electronic device chargers, reading materials and drugs are tucked away.  This was not a "typical" road trip for me; I did not plan on running, therefore I did not expect to endure (my) "typical" running-related aches and pains.  Fortunately for me there was a store up the block from the reception hall, so I was able to grab up a non-steroidal anti-inflammatory drug (NSAID) of choice, in this case ibuprofen. 

Suzanne can get pain relief from almost any over-the-counter NSAID (aspirin, acetaminophen, ibuprofen, or naproxen being the most common versions), whereas I am a little more picky.  I have to be.  I rummaged through the kitchen cabinet, desperately searching for ibuprofen last week, when Suzanne pulled out a box of "ibuprofen with diphenhydramine" capsules.  I graciously declined, and informed her that the Benadryl she offered along with the ibuprofen would make the ache go away to my satisfaction, but I would be on the couch for the afternoon.  Sometimes I'm anal retentive like that.  (One of the few times where my 14-year medical transcription career was beneficial after college.)

So why can some folks take any NSAID and others (like me) require a specific compound? 

When we do damage to ourselves the body begins to repair the damage through the inflammatory response.  This response involves the release of enzymes and chemicals which begin the restoration of damage...and transmit "it hurts when I do that" messages to the brain so we will stop doing what hurts.  NSAIDs are divided into two categories: selective inhibitors and non-selective inhibitors, based on the enzyme which is inhibited from production (and transmission), known as COX-1 and COX-2.  Inhibit the COX-1 enzyme too much and you run the risk of ulcers, stomach bleeding, and prolonged bleeding time.  Most of the over-the-counter NSAIDs are pretty much non-selective, which means they inhibit  both enzymes in varying degrees.  Selective inhibitors (all of which require a prescription) focus more closely on the COX-2.  Runners who might be taking drugs to thin their blood, or bruise easily might want to take an NSAID other than aspirin, since aspirin can slow the clotting of blood for 4-to-7 days, where other drugs only slow blood clotting for a few hours.

The best over-the counter NSAID for each person, like any training plan or shoe, depends on age, cause and severity of the pain, as well as what your stomach can tolerate.  After a week take the time to figure out if the drug helped ease the inflammation with no side effects.  A single-blind test of over-the-counter NSAIDs found naproxen gave greatest relief from pain, followed by aspirin and ibuprofen.

But NSAIDs do not heal pain, they decrease the inflammatory response and the pain messages sent to the brain.  No drug can replace the common sense factors of rest, analysis of what caused the pain, and correction of the causes.  After you figure out what happened then it's time to get back out on the road.