Effect of nonsteroidal antiinﬂammatory drugs on fracture healing: a laboratory study in rats. It’s about being able to involve the Legal Pain market-Pharma companies in order to sue for billions. And when I sustained my own fracture their, it is what I used on myself. 2007;127(1):3-9. Scand J Rheumatol. J Oral Maxillofac Surg. This enzyme is an important effort in increasing inflamation, inhibiting it makes you hurt less. Treatment with paracetamol, ketorolac or etoricoxib did not hinder alveolar bone healing: a histometric study in rats. Vuolteenaho K, Moilanen T, Moilanen E. Non-steroidal anti-inflammatory drugs, cyclooxygenase-2 and the bone healing process.Basic Clin Pharmacol Toxicol. Anti-inflammatory drugs commonly used to relieve pain after shoulder surgery may impair healing, new animal research suggests. 1990;61(1):66-9. I have also tried walking – moderate exercise, meditation. There is loads of info re the adverse effects of NSAIDS on bone healing but thats it! Mol Pharmacol. Otherwise, I just want to lie down and not move! Fractures heal. Interestingly enough, I found many animal studies which compared the effects of COX2 selective NSAIDs with non-selective NSAIDs in delaying fracture healing. This is really helpful to all.please let me if you have more information. Obeid G, Zhang X, Wang X, et al. I immediately shot an email off to Gaby asking why, if I'm not supposed to have NSAIDs for three months, was I given them right after surgery. Many trials looked at fracture healing as early as 21 days post-surgery and at latest, 12 weeks post-surgery. I couldn’t agree more, especially when using non-selective NSAIDs for 3 months opr longer prior to the procedure where one is predisposed to cardiovascular risk. The desire to continue the rehab of the leg is very important and to have some pain management that is less agressive as the opiates is what most are looking for. Less than .05% of those that take legal pain meds abuse. My intolerance for medications extends to NSAIDs if the maximum recommended dose per day is met for even one day, so abusing them was never an issue — I just used them regularly for years. While some studies concluded COX2 selective NSAIDs delayed fracture healing more than their non-selective NSAID counterparts (such as ibuprofen or naproxen), many other studies found the opposite to be true. Through my extensive literature research I found that the effects of NSAIDS on bone healing were undoubtedly inconclusive. may significantly impact opioid abuse. Pharmacology. 2003;85-A(4):632-4. Bergenstock M, Min W, Simon AM, et al. At higher doses of ibuprofen(ie. Doctors Are”, Graeme Wood criticizes his dentist for prescribing hydrocodone to relieve pain after his wisdom tooth extraction. Ibuprofen may also cause stomach or intestinal bleeding, which can be fatal. St. Louis, MO 63141, 5201 Midamerica Plaza Life has pain. Where does quality of life come into pain. We need to be reminded that NSAIDs are not a “free pass.”. Clin Orthop Relat Res. Patients are often instructed not to take ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) before or after surgery because of increased bleeding risk. 2007;89(3):500-11. After surgery and especially during the early healing process patients are at both increased risk of clotting and increased risk of bleeding. I need to take aspirin and Plavix every day. I do not believe I should be telling my orthopedic colleagues how to manage their surgical patients. Effect of COX-2 inhibitors and non-steroidal anti inflammatory drugs on a mouse fracture model. 1992;63(6):607-11. Finding this incredibly difficult and started looking for articles and information on this as it has such an impact on pain management and recovery. After having decompression, bone graft fusion surgery of my c 5-7 vertebrae – narcotics and opiods were prescribed. Effects on remodelling of rabbit bone. Pain 2003;103:199–207. J Physiol Anthropol Appl Human Sci. I for one was mortified last year when asked to lecture to a large healthcare system in the Northeast. J Neurosurg Spine. Differential effects of nonsteroidal anti-inflammatory drugs on constitutive and inducible prostaglandin G/H synthase in cultured bone cells. “Conservative calculations estimate that approximately 107,000 patients are hospitalized annually for nonsteroidal anti-inflammatory drug (NSAID)-related gastrointestinal (GI) complications and at least 16,500 NSAID-related deaths occur each year among arthritis patients alone. Conclusions of my literature review matched that of many other review articles and expert opinion articles published on the topic. Experimental study of the action of COX-2 selective nonsteroidal anti-inflammatory drugs and traditional anti-inflammatory drugs in bone regeneration. Recently severe GI problems were identified as a result of this. Why? I just had surgery and was taken off nsaids altogether and have found the pain meds do little to nothing for the throbbing and swelling. 1980;9(3):167-71. Postoperative modulation of central nervous system prostaglandin E2 by cyclooxygenase inhibitors after vascular surgery. Zhang X, Schwarz EM, Young DA, et al. Patients who quit smoking after surgery for longer than six months had a nonunion rate of 17%. Intense pain soon after wrist fracture strongly predicts who will develop complex regional pain syndrome: prospective cohort study. Cardiac arrest tops the list of potential problems with taking this commonly used drug.. As if we needed another reason to question taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, a new study has concluded that taking these drugs increases the risk of c ardiac arrest by a whopping 31 percent. Really depends on the situation. Coumadin – discuss this with the prescriber as to the best time to stop this medication before surgery. 2002;84-A(10):1763-8. 2002;109(11):1405-15. The figures of all NSAID users would be overwhelming, yet the scope of this problem is generally under-appreciated.”, http://americannutritionassociation.org/newsletter/deadly-nsaids, Your email address will not be published. It was absolutely horrible. Click here to see Cox-2. She changed the antibiotic to Clindamycin and offered some tramadol, to which my friend said no way. In my case – I have been taking Mobic max dose for 20 years for joint issues. Because the reimbursement model is based on their pain scores – and that may have been more important to the institution than doing the right thing medically. Effects of a cyclooxygenase-2 inhibitor (rofecoxib) on bone healing. 1992;63(3):330-3. Your email address will not be published. A population based study by Sandroni et al, found that previous fractures was the most common trigger for CRPS in 46% (34 out of 74 cases) of identified patients with CRPS. Reuben SS, Pristas R, Dixon D, Faruqi S, Madabhushi L, Wenner S. The incidence of complex regional pain syndrome after fasciectomy for Dupuytren’s contracture: a prospective observational study of four anesthetic techniques. There have been no randomized controlled trials on the effects of NSAIDs on post-operative healing in humans. You may take Tylenol unless otherwise instructed not to do so. Due to his positive findings, many physicians began routinely prescribing COX2 selective NSAIDs for the management of post-operative pain. Giordano V, Giordano M, Knackfuss I, et al. Alright, whew, so finally if you are going to take an NSAID drug after an injury I’d probably only do it once, akin to the study on people who took ibuprofen once after exercising. 1998;57(3):148-59. We recently conducted a study that found many patients are able to manage their pain after surgery with Over-the-Counter (OTC) medications such as Tylenol and Motrin. Pain related to orthopedic surgery, dental extractions, or any injury that involves connective tissue is caused in large part by inflammation which occurs because of prostaglandin release into the surrounding tissues. minimal help. Certainly some patients could benefit from the combined use of NSAIDs plus opioids – this should presumably have been true for a case such as the well-publicized basketball injury endured last year by Louisville athlete Keven Ware. Comparison between the effects of dexamethasone and indomethacin on bone wound healing. Cyclooxygenase-2 regulates mesenchymal cell differentiation into the osteoblast lineage and is critically involved in bone repair. I would give them a call. Postoperative analgesic effects of celecoxib or rofecoxib after spinal fusion surgery. Marilyn, I cannot give medical advice on this forum. Always take ibuprofen tablets and capsules with food or a drink of milk to reduce the chance of an upset stomach. Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs. 1998;156(1):51-7. J Orthop Sci. I was asked to address some seemingly very simple questions. Now our politicians are destroying Medicine, outlawing Morphine because a few Heroin addicts died, their Rich parents are now using their riches to destroy LEGAL opioids as there is no one to sue in the ILLegal Market, and politicians have joined those parents to get some illicit money!! While teaching on general concepts of acute and chronic pain management, I learned that patients frequently were admitted through the emergency department for 2-3 days at a time pretty much to receive intravenous hydromorphone (aka Dilaudid) for unidentified pain. Allen HL, Wase A, Bear WT. Fascinating article about using NSAIDs after surgery. John Laudenslager, Over the years since 2002 I have had a hip replacement (AVN after hit by a car) several years later the other hip was replaced due to OA, 2012 was my first knee replacement and 2014 my second (both done at NE Baptist hospital in Boston) Significant pain pre and post replacements. 800 mg three times a day) there can be a potential for thinning of the blood but it is a "reversible" effect where as aspirin has an "irreversible" effect. I found this article helpful and hope there is indeed more research going on. Due to his positive findings, many physicians began routinely prescribing COX2 selective NSAIDs for the management of post-operative pain. If you have a condition that does not allow you to take Tylenol or Motrin, notify your surgical team. Withholding the correct medications for pain for whatever reason , fear, is ridiculous. Indian J Orthop. St. Louis, MO 63110, 13001 N Outer Forty Road These articles emphasized the contradictory nature of the topic and the need for large randomized clinical trials in humans. Now, the profession is in shambles after an investigation revealed that at least 21 of Reuben’s papers were pure fiction, and that the pain drugs he touted in them may have slowed postoperative healing.” After this, orthopedists began to question the validity behind prescribing NSAIDs for post-operative pain. Torkvist H, Lindholm TS, Netz P, et al. Do not resume these medications until your doctor says that it is okay. Medications that increase the chances that you will bleed excessively after surgery include: After shoulder surgery, you should avoid all anti-inflammatory medications including ibuprofen (Advil, Motrin) and Naprosyn (Aleve) and any other prescription anti-inflammatories, unless your surgeon prescribes them. Do not use this medicine if you have just had heart bypass surgery (also called coronary artery bypass graft, or CABG). Going to help?’ Given that the first week post Keller J, Bunger C, Andreassen TT, et al. your content is out of the funnel. Braz Dent J. 2014;15(1):16-23. 4921 Parkview Place COX2 selective NSAIDs include celecoxib (Celebrex), rofecoxib (Vioxx, taken off market), and valdecoxib (Bextra, taken off market). Endo K, Sairyo K, Komatsubara S, et al. Show your doctor this blog!!! Anecdotally, I don’t have patients call me (and they get my cell number) needing extra medication after surgery and Ibuprofen 800mg preoperatively is why I believe that is so. Ibuprofen does a good job of relieving the pain of simple fractures and is safe for short-term use for people who don’t have kidney disease or a history of stomach ulcer. Temporal effects of a COX-2-selective NSAID on bone ingrowth. 2007;89(1):114-25. Cyclooxygenase-2 inhibitor inhibits the fracture healing. A limited study, to be sure. Many studies have found fractures and post-operative pain as risk factors for the development of CRPS. Effects of short-term treatment with corticosteroids and indomethacin on bone healing. She completed her Doctor of Pharmacy degree at the University of Florida, College of Pharmacy. O’Connor JP, Capo JT, Tan V, et al. A prospective randomized trial on the role of perioperative celecoxib administration for total knee arthroplasty: improving clinical outcomes. Aside from these facts, this 2014 article in The New Republic: “Drug Dealers Aren’t to Blame for the Heroin Boom. I used to take ibuprofen for pain, but a neighbor said I shouldn’t take it if I’m on aspirin and Plavix. The ASPS states ibuprofen doesn’t increase the risk for excessive bleeds. 1985;37(2):148-57. I am seeing 1st hand the need to move off of opioids to something with less side effects of constipation and drowsiness. Hope things got bettet? Nefussi JR, Baron R. PGE2 stimulates both resorption and formation of bone in vitro: differential responses of the periosteum and the endosteum in fetal rat long bone cultures. It seemed obvious to me the antibiotic was not working and now she had a large white ulcer on her tongue from where the jawbone was protruding. NSAIDs delay bone healing through their inhibition of prostaglandins. Elves MW, Bayley I, Roylance PJ. Am J Orthop (Belle Mead NJ). I became a Physicians Assistant in 1980, had my own first significant orthopedic surgery (total knee replacement) two weeks ago, and notice from then to now it was and is possible to find those who say NSAIDs harm, don’t affect, or help healing post op. I was told by my surgeon absolutely no ansaids. Dennis, I cannot give medical advice on this forum. Reuben S. The effect of intraoperative valdecoxib administration on PGE2 levels in the CSF. This study estimated an incidence rate of CRPS as 5.46/100 000/year. A critical analysis. Why? Why can't I take ibuprofen during treatments? The only time I’m not in pain is when I am in a warm bath with Epsom Salts. Why does the doctor ask you to take ibuprofen before surgery? COX-2 selective NSAID decreases bone ingrowth in vivo. Now every patient, Elderly, disabled, Veterans, Patients with Chronic severe disease, ERpatients, Drs, are being harassed, having their pain meds taken away, and they are Suffering Horribly. Always x strength tylenol suggested (never effective for me) I don’t want to delay my foot from healing. 2011;16(1):93-8. 2003;123(7):327-32. The article is very interesting and maddeningly inconclusive. Required fields are marked *. Or should they? 12 weeks showed no sign of healing. Orthopedists today generally hesitate to treat post-operative pain with the COX2 selective NSAID celecoxib (Celebrex). Sadly the author was not able to find answers to the very questions I have – ie if NSAIdS are discontinued after surgery is the impact on bone healing reversible? Simon AM, O’Connor JP. Injury. Ibuprofen is on the list because it’s believed it may increase the risk for excessive bleeding during and after the procedure. Opioids prescribed post op but not used after 2-3 weeks home. Re: NSAIDS in the peri-operative period, one must also consider the potential cardiovascular downside of stopping NSAIDs cold. Please share opinions. Boiskin I, Epstein S, Ismail F, et al. I suggested Tylenol 3, since NOTHING ELSE can be called in. I quickly found out that they weren’t so simple after all and the absence of evidence was astonishing and perhaps even unjustifiable. ibuprofen is a blood thinner, just like aspirin and ideally should be avoided 2 weeks prior to surgery. While some studies concluded COX2 selective NSAIDs delayed fracture healing more than their non-selective NSAID counterparts (such as ibuprofen or naproxen), many other studies found the opposite to be true. It try 1 advil and 1 Tylenol when the pain is severe. While the data is lacking on which fractures or surgeries most commonly increase the risk for developing CRPS, the most common ones seen through a literature search included fractures of the distal radius and post total knee arthroplasty, after fasciectomy for Dupuytren contracture, and after carpal tunnel surgery. J Pain. The other day I was in such pain at work I took an Aleve even though I knew it was contraindicated for the bone graft healing. Acta Orthop Scand. Perhaps She needs to review benefits versus risks, the supportive literature or lack thereof and make a decision after a complete review which I have laid out here. 2005;19(10):717-23. The standard is to stop certain medications 1 week prior to surgery. (until off the market) then ibuprofen, tylenol PM at night. Evaluation of digital optical density of bone repair in rats medicated with ketoprofen. on Is it safe to take NSAIDS following orthopedic surgery? The research team was led by Louis J. Soslowsky, Ph.D., vice chair for Research in the Department of Orthopaedic Surgery at the University of Pennsylvania. J Bone Joint Surg Am. It’s a dose I have taken occasionally in the past for sprains and strains, with no ill impacts other than easy bruising. Taking painkillers after your surgery . In others cases, low-dose aspirin may be continued based on your medical condition. Fracture healing in rats inhibited by locally administered Acta Orthop Scand. Etodolac (Lodine) too is very COX2 selective however has never been marketed as such. The exact pathophysiology of this disease state is not understood and therefore treatment of this syndrome is difficult. "i've had a roux-en-y gastric bypass and i've been told to avoid ibuprofen products can i take naprosyn (naproxen) ?" Does the avoidance of NSAIDs have potential for elevating intolerable pain that could otherwise be kept at bay? Unfortunately, understanding how to effectively deal with all of this as both a health problem and a national economic problem is still clouded n mystery. Is it safe to take NSAIDS following orthopedic surgery? 1990;9(3):383-90. Complex regional pain syndrome is a chronic systemic disorder characterized by pain in combination with sensory, autonomic, trophic, and motor abnormalities. 2010;18(6):630-4. 2008;102(1):10-4. de Mos M, de Bruijn AG, Huygen FJ,et al. Martins MV, da Silva MA, Medici Filho E, et al. Doctors give trusted answers on uses, effects, side-effects, and cautions: Dr. Pothiawala on can you take ibuprofen after surgery: Usually physicians will hold these medications for about 5 days. That means that after two hours, only half of the drug will be remaining in your system. Please make sure that you read these leaflets alongside this one. This doctor actually called in 12 Tylenol 3s. Relief was obtained with Vioxx, The effects of the short-term administration of low therapeutic doses of anti-COX-2 agents on the healing of fractures: an experimental study in rabbits. Patients usually begin to feel a little stronger each day at this point after lumbar fusion surgery, but need to be aware of infection risks and medication safety issues.. Incision Healing. New research suggests that ibuprofen does not increase the risk of bleeding after plastic surgery procedures. I started feeling sick and had diarrhea and felt I should stop with Tylenol get a new script and use heat. Unfortunately I can’t bring my bath to work. Do not resume these medications until your doctor says that it is okay. While using cane for balance I injured my rotator cuff L shouider. I find it refreshing to find someone admitting when there is no unarguable answer. J Bone Joint Surg Am. 2004;86-A(1):116-23. Since there is no consensus, I prefer to not wishfully believe there is. After discontinuation of the NSAID, does time eventually make up for the delayed bone healing, and if so, are there adverse consequences? If you are unable to take Celebrex, acetaminophen alone may be sufficient. In some cases, we may recommend stopping your aspirin 1 week before surgery. Sandroni P, Benrud-Larson LM, McClelland RL, et al. Lin CH, Jee WS, Ma YF, et al. 1984;(187):255-9. Utvag SE, Fuskev OM, Shegarfi H, et al. The effect of cyclooxygenase-2 inhibition on analgesia and spinal fusion. According to a DEA Resource for Parents updated in 2012 Prescription for Disaster – How Teens Abuse Medicine, “Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month. have severe osteoarthritis and needed an anterior cervical diskectomy fusion. J Orthop Res. 2005;76(4):470-4. Suite 1500 Town and Country, MO 63017, 14532 S. Outer Forty Drive Pain 2007;129:12–20. Calcif Tissue Int. Effect of ibuprofen on mass and composition of fracture callus and bone. Incorrect. Etodolac (Lodine) too is very COX2 selective however has never been marketed as such. He told OTW , “There has been a lot of interest from our lab and others on the role of non-steroidal anti-inflammatory drugs (NSAIDs) on … I worked 3 years in a Third World setting. Effect of tenoxicam on fracture healing in rat tibiae. Altman RD, Latta LL, Keer R, et al. Recently, a close friend endured a very complicated wisdom tooth extraction, made much worse due to the abscess of the gum and root entanglement with the jawbone. In essence, over the course of 12 years, “anesthesiologist Scott Reuben revolutionized the way physicians provide[d] pain relief to patients undergoing orthopedic surgery for everything from torn ligaments to worn-out hips. A comparison of the effects of ibuprofen and rofecoxib on rabbit fibula osteotomy healing. Leonelli SM, Goldberg BA, Safanda J, et al. I have just posted on this site – see above. Complex regional pain syndrome is a chronic systemic disorder characterized by pain in combination with sensory, autonomic, trophic, and motor abnormalities. Jpn J Pharmacol. Finally relief. The effects of nonsteroidal anti-inflammatory drugs on posterior spinal fusions in the rat. 2009;80(5):597-605. 1996;21(16):1870-6. However in 2010, it was found that Dr. Reuben fabricated the data in at least 21 of his articles. After a fracture, doctors often prescribe ibuprofen to help relieve the pain and swelling of a broken bone. More than 68k OD on tylenol last year. Cyclooxygenase-2 inhibitor delays fracture healing in rats. After shoulder surgery, you should avoid all anti-inflammatory medications including ibuprofen (Advil, Motrin) and Naprosyn (Aleve) and any other prescription anti-inflammatories, unless your surgeon prescribes them. Please discuss with your surgeon. Upon hearing the doctor on-call was someone we had known for thirty years, we felt better about the situation. Mechanism is thought to be preventing prostaglandin formation leading to less pain and swelling. Without such evidence, the widespread use of routine anti-inflammatory-based treatment after major orthopaedic surgery may well result in harm … All patients experience some pain in their face and neck after surgery. 1 Some symptoms to be aware of include: Fever (101 degrees or higher) If this goes on, by the time this is over I’ll be addicted to pain killers and I’ll have an even bigger problem in my hands. Spine. Ambulation and sleep are Indomethacin and aspirin: effect of nonsteroidal anti-inflammatory agents on the rate of fracture repair in the rat. Control of how they feel and to get back to normal would be the goal, hoping not to slow the bone healing that the NSAIDS might do. Are the diminished bone-fusion effects (if valid) reversible without adverse consequences once the NSAID is discontinued? Beck A, Krischak G, Sorg T, et al. You may take Tylenol unless otherwise instructed not to do so. But, many studies have also found that COX1, and especially COX2, also play an essential role in bone formation, bone union, and resorption following a fracture. Thank you so much for this article. ! Ibuprofen (Advil, Motrin) - stop 1 week prior to surgery, Naprosyn (Aleve) - stop 1 week prior to surgery, Plavix – discuss this with the prescriber as to the best time to stop this medication before surgery. Effects of a selective cyclooxygenase-2 inhibitor (celecoxib) on fracture healing in rats. Op is the most important for the inflammatory After an extensive literature search, I was unable to find compelling evidence to unequivocally answer these dilemmas, but new questions surfaced. But I did find aroma therapy candles seem to help calm the nerves and relax and ease pain. The final decision of course needs to come from your doctor. To get a handle on how much and when nsaids are started post op would be a good study….. But, there has been much unsubstantiated controversy over whether or not NSAIDs are beneficial or detrimental in cases involving bone healing. Do not take it on an empty stomach. I share your frustration re no info available on stopping NSAIDs after surgery and timeframes re starting etc. Even with short term use, one’s heart attack and stroke risk increase significantly. “Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month. Do nonsteroidal anti-inflammatory drugs affect bone healing? Although most of these pills were prescribed for medical purposes, many ended up in the hands of people who misused or abused them.” (CDC Vital Signs, Nov. 2011) We know that 70% of youth get their prescription drugs from family and friends, yet fewer parents report safeguarding prescription medications. We would love to have some feedback/opionions from clinicians and patients to share their experiences. Effects on bone metabolism and strength of rabbit osteotomies. Ibuprofen can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Animal studies investigating the effects of prostaglandins on bone healing: Animal studies concluding NSAIDs impair bone healing: Animal studies concluding NSAIDs have no effect on bone healing or in short term have no effect on bone healing: Review Articles/Expert Opinion on the effects of NSAIDs on bone healing: The List of Studies by Scott S. Reuben, MD, That Have Been or Likely Will Be Recalled relating to use of NSAIDs post-surgery. Answers (1) Yes, you can switch it off with the Tylenol, but you can't take them together. St. Louis, MO 63129, 20 Progress Point Parkway, Suite 114 In January 2016 I suffered a spiral femur fracture and had surgery. Any info/research/feedback gratefully received! DEAR READER: Taking aspirin and Plavix after angioplasty and stent placement is standard care. It’s very frustrating. Machwate M, Harada S, Leu CT et al. 2006;88 Suppl 3:140-7. All rights reserved. Tylenol 3 works for about 3, 4 hrs, then the shooting pain and throbbing combine into a symphony of torturous pain. J Orthop Res. While extremely sore and suffering quite a bit by that night, she improved until about three days later, or Thursday that week. It inhibits platelet Cyclooxygenase - Wikipedia. J Endocrinol. 2008;79(4):548-54. Acta Orthop. Acetominophen (Tylenol) does not have that effect and can be taken instead. Riew KD, Long J, Rhee J, et al. She received a mouth rinse, some Peninicillin VK, and 14 Motrin, 400 mg. The exact pathophysiology of this disease state is not understood and therefore treatment of this syndrome is difficult. Anat Rec. Thank you for this site Pam, Hello, do you allow guest posting on paindr.com ? Brown KM, Saunders MM, Kirsch T, et al. If I take ibuprofen (400 mg) once or twice a day, it aids me in my walking. Arch Orthop Trauma Surg. 2013 Jul;47(4):395-401. Avoid ibuprofen if you have a history of asthma or hives due to aspirin use or other NSAIDs, like naproxen. 2005;16(3):207-12. To give [NSAIDs] or not to give [NSAIDs]; that is the question! The effect of cyclooxygenase-2 inhibition on acute and chronic donor-site pain after spinal-fusion surgery. Vaishali Shah is a PGY-1 Pharmacy resident at the Stratton VA Medical Center in Albany, NY. Indomethacin and bone remodeling. Murnaghan M, Li G, Marsh DR. Nonsteroidal anti-inflammatory drug-induced fracture nonunion: an inhibition of angiogenesis? This study estimated an incidence rate of CRPS as 5.46/100 000/year. 2003;21(4):670-5. My chronic pain and depression are worse. Yet, because death from NSAIDs is not considered a “character flaw” (i.e., addiction), and even perhaps a “nobler” way to die than from opioids, there is no public outcry – despite the fact that people continue to die by the thousands from NSAID related complications. 2006;80(1):67-73. The influence of Ibuprofen on fracture repair: biomechanical, biochemical, histologic, and histomorphometric parameters in rats. 2007;7(6):631-6. Dr said not to take at all, said take Tylenol arthritis for pain. 2004;3(2):131-136. 1989;30(1):27-35. Krischak G, Augat P, Sorg T, et al. Back in 2005, the FDA issued a warning about ibuprofen, saying it significantly increases one’s risk of heart attack or stroke.Well just last year, they made the decision to strengthen this warning. Prostaglandin H2 is the precursor to active prostaglandins and thromboxane.