Studies have shown that people who take anti-inflammatory painkillers have a small but significant increase in the risk of developing a heart attack or stroke . Although it can occur in anybody, the risk is mainly in people already known to have cardiovascular problems such as angina or peripheral arterial disease , and in the elderly. Perhaps the highest risk is in people who have previously had a heart attack. For example, one research study looked at people who had previously had a heart attack. The results showed a marked increase in the rate of a second heart attack in people who were taking an anti-inflammatory compared to those who were not.
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.
In total, 65 trials (total number of patients = 11,237) were included in this review . Twenty-eight trials (42%) were considered high quality. Statistically significant effects were found in favour of NSAIDs compared to placebo , but at the cost of statistically significant more side effects. There is moderate evidence that NSAIDs are not more effective than paracetamol for acute low-back pain, but paracetamol had fewer side effects. There is moderate evidence that NSAIDs are not more effective than other drugs for acute low-back pain. There is strong evidence that various types of NSAIDs, including COX-2 NSAIDs, are equally effective for acute low-back pain. COX-2 NSAIDs had statistically significantly fewer side-effects than traditional NSAIDs.