The inflammatory process occurs in many different disease states. It is responsible for the pain and swelling of sprains and strains, arthritis, for the redness and pain in a sore throat, for the redness and itching of eczema, for the sneezing and fluid-filled nose that comes with hay fever. This article is mostly concerned with inflammation in the musculoskeletal system.
How is inflammation useful?
Section titled “How is inflammation useful?”If a splinter gets into a joint, it introduces bacteria. These stimulate an inflammatory response. As part of this response, the joint will become red, swollen, and stiff. This response helps remove the splinter, and ends when the invading bacteria are eliminated.
Inflammation is not always caused by infection. A blow or a strain to a joint can contuse the joint lining and lead to an inflammatory response. The joint lining becomes red, swollen, and difficult to move. This occurs due to irritation of the damaged tissues from trauma, rather than from bacteria.
In the natural course of events, the inflammatory process will turn itself on and then off. Again, take the case of a splinter, this time under the skin. The bacteria on the splinter will initiate an inflammatory response, this will cause pus to build up around the splinter and the splinter will then either be removed or fall out. At that time the inflammation will disappear and the skin returns to normal.
However, there may be times, usually when we are older or with a severe strain to a joint or tendon, that this inflammatory process might go on beyond the point that it is needed. This can occur with arthritis, with tendonitis, with bursitis and with many other musculoskeletal problems. Sometimes the prolongation of the inflammatory response can be due to a deficiency of essential fatty acids or other nutrients. In such a case we often prescribe beneficial fatty acids. Sometimes there are other reasons for prolonged inflammation, and physical therapy or dietary changes may help.
What anti-inflammatory agents may help excessive inflammation?
Section titled “What anti-inflammatory agents may help excessive inflammation?”These include the old favorite, aspirin, as well as newer agents such as ibuprofen or piroxicam. These are generally best used at full doses for 10 days to 2 weeks. What these do is inhibit some of the biochemical steps in the inflammatory response and prevent the fatty acids from being transformed into leukotrienes and inflammatory prostaglandins. It takes a full inflammatory dose of these drugs to cause this to happen. Using less than the anti-inflammatory dose is like not putting enough water on a fire. The fire may sputter but it won't go out.
Essential fatty acids such as those from cod liver oil, flax seed oil and evening primrose oil will generate substances that inhibit or stop the process of inflammation.
The fatty acids in meat are different. These can generate substances that promote inflammation.
Natural anti-inflammatory agents
Section titled “Natural anti-inflammatory agents”At our reception desk we have information about Boswelya, a combination of boswellic acid, ginger, and winter cherry. Two capsules three times a day has proven very helpful, especially for people with long-term inflammation, such as arthritis.
The essential omega-3 fatty acids help reduce inflammation. You can obtain these in cod liver oil (two teaspoons a day) or fish oil capsules. Look for a daily dose of about 1000 milligrams of EPA and somewhat less DHA.
Pharmaceutical anti-inflammatory drugs
Section titled “Pharmaceutical anti-inflammatory drugs”These agents are called NSAID's (Non-Steroidal Anti-Inflammatory Agents).
Side effects
The greatest danger is stomach ulcer. Eighty percent of the time, bleeding occurs with no symptoms. This occurs more with advancing age, higher doses, previous ulcer, serious illness, and use of other NSAIDS, corticosteroids, or anticoagulants. Use of NSAID's with diarrhea or inadequate fluid intake can lead to permanent kidney failure. For prolonged use, you should consult your physician.
Acetaminophen (Tylenol®), while a good pain reliever, has no anti-inflammatory effect. Taken with alcohol, it can destroy the liver.
The following anti-inflammatory agents are listed by order of ease of use, easiest first.
Piroxicam is available by prescription only. One capsule lasts for 24 hours. It is a good choice if you are very busy or if you have trouble remembering to take medicine several times a day.
Naproxen can be taken just twice a day. Aleve is available over-the-counter, and the dose varies.
- one 220 milligram tablet twice a day if over 65 years of age
- two tablets in the morning, then one 12 hours later if aged 15 to 65
- two tablets twice a day under medical supervision.
Naproxen is also available by prescription.
Ibuprofen is available over the counter in 200 mg tablets. It is less expensive from the pharmacist in 800 mg tablets. The general dose for a healthy adult is 800 mg three times a day. People over 65 should take no more than 600 mg three times a day.
Note: The above drugs are usually easier on the stomach than aspirin and don't seem to cause ringing in the ears.
Aspirin is derived from the willow tree. The salicylic acid from bark of the willow tree is chemically altered to make it more powerful. Aspirin can cause bleeding from the stomach. Coated aspirin taken on an empty stomach can bypass the stomach and help many people get around this problem. Aspirin taken for a few days might cause or increase ringing in the ears, so if you are prone to that, don't take aspirin.
However, if your ears don't ring and you have a strong stomach, aspirin is hard to beat in terms of price and effectiveness. Although some of the newer anti-inflammatory agents seem to cause less side effects than aspirin, we are still learning about them. One of them seems to increase the risk of heart disease. We know that aspirin has faults but at least we aren't going to find too many surprises with it.
How to take aspirin: I suggest 2 tablets with each meal and at bedtime. It is easier on your stomach when taken with food. Take it at bedtime with some food or hot milk.
Celebrex, Bextra & newer drugs. These newer anti-inflammatory agents are no more effective than the older ones. They are much less likely to cause gastsrointestinal bleeding. If you do not tolerate the older drugs, or have a history of ulcer or GI problems, these drugs are worth their extra expense.
Summary
Section titled “Summary”As we hinted at the beginning, inflammation plays a part in many illnesses. The treatment guidelines in this handout are mostly concerned with inflammation as it occurs in the musculoskeletal system. Inflammation in the skin with eczema or in the respiratory system with asthma or hay fever is treated differently. One similar point with both situations though, is that when the inflammation settles down, the illness, be it asthma or joint pain, tends to go away for a while and only return when some unfortunate occurrence kicks it off again. Once it starts it may be self-perpetuating until you do something to stop it.