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Over-the-Counter Pain Relief

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Martial Arts of Japan

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by Michael Nickels, M.D.

    Sore muscles and joint pain are frequent consequences of a vigorous martial arts workout, particularly one that involves numerous breakfalls. To obtain relief, most of us reach for an over-the-counter (non-prescribed) pain reliever. We are not alone in this regard, as Americans typically spend billions of dollars annually on these medications. In the United States, we currently have the choice of four non-prescription pain relievers packaged under a variety of trade names, delivery systems and dosages.

Generic Name                     Common Trade (Brand) Name
Aspirin                                 Bayer
Acetaminophen                   Tylenol, Panadol
Ibuprofen                             Advil, Motrin, Nuprin
Naproxin                              Aleve, Anaprox

    Each of these has the ability to ease muscle and joint pain; however, each also has characteristic risks and benefits that should be carefully weighed before deciding which is right for you.

    Aspirin, ibuprofen and naproxin belong to a class of pharmaceuticals known as non-steroidal anti-inflammatory drugs (NSAIDs) that reduce inflammation, pain and fever. Aspirin also thins the blood by irreversibly decreasing the ability of platelets to clot. This latter property has prompted recent recommendations that men over 40 years of age take an aspirin a day to decrease their risk of coronary artery disease (more on this in a future article).
    Many individuals, including myself, find that ibuprofen is a more effective pain reliever than aspirin. For relief of mild to moderate muscle or joint pain, 400 mg of ibuprofen or 650 mg of aspirin every four to six hours should be sufficient. For more severe or chronic joint pain 600–800 mg of ibuprofen may be used. Never exceed 3.2 g of ibuprofen or 4 g of aspirin a day. Use of these medications for greater than ten days should prompt a visit to a physician.
    Another alternative is naproxin, which may be thought of as long acting ibuprofen. This pain reliever is typically prescribed at 250 to 500 mg doses, twice a day. Unless you are suffering from chronic pain, however, it is probably better to use the shorter acting ibuprofen to avoid over-treating your symptoms.
    The major, adverse side effect of NSAIDs is stomach irritation, possibly leading to ulcers. Some evidence indicates that ibuprofen has less gastric side effects than aspirin. Regardless, the risk for this outcome may be significantly reduced by taking the medication with food or a glass of milk. It is also important to remember that aspirin should never be given to a febrile (feverish) child under the age of 16, due to the possibility of developing Reye’s Syndrome, a potentially fatal neurological disorder. Unlike aspirin, ibuprofen is considered safe for children with fevers.

    Acetaminophen is an effective pain reliever; however, it has no anti-inflammatory properties and is therefore not as effective as NSAIDs in providing relief from muscle or joint pain. It has relatively few side effects at the standard dose of 650 mg every four to six hours and is the drug of choice for patients with stomach ulcers or other contraindications to NSAID use. Acetaminophen is extremely dangerous when excessive doses are taken, often resulting in liver damage or death if appropriate medical treatment is not obtained.

Recommendation: For muscle or joint pain secondary to an intense martial arts training session, 400 mg of ibuprofen every four to six hours as needed is probably the best choice. Individuals with a history of gastric ulcers or an allergy/insensitivity to ibuprofen should use 650 mg of acetaminophen instead. Individuals with a history of kidney disease should consult their own doctor for proper dosage recommendations.

Michael Nickels received an M.D. and a Ph.D. in Biomedical Science (Microbiology and Immunology) from the University of South Carolina School of Medicine.

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