I was wondering whether someone with a greater
knowledge than myself regarding the action of
anti-inflammatory medications, could answer this
question. Electrotherapy modalities such as
ultrasound and pulsed magnetic energy have been termed
"pro-inflammatory" in recent years because it is
beleived that they "speed up" the inflammatory
process, facilitating healing. An article which I saw
a few months back made the conclusion that therefore,
NSAIDs and ultrasound have opposing actions. Is this
the case ? And if so, in the case for example of a
soccer player post-injury who has been prescribed
NSAIDs, is ultrasound opposing rather than
complimenting the effects of these drugs ?
Many thanks,
Nick Bent, B.Sc (Hons), MCSP, SRP
___________________________________________________________________
Dear Nick,
In a sense your conclusion is true...however I might word it a little
differently. The NSAID is actually opposing the benefits of Ultrasound (US)
. There are few benefits, IF ANY, of using NSAID's in a young healthy person
such as a soccer player who has suffered a mechanical wound. He is not
suffering from a disease, therefore I question the medical community's use
of theses drugs. These drugs may help in cases of systemic disease, but they
do more harm than good when used to treat mechanical injuries.
US on the other hand works because it enhances the early arrival of
inflammatory cells to the wounded area to first: begin phagocytosis, and
secondly to begin the repair process. These phagocytic cells release
proteases and collagenases to degrade damaged structures and release growth
factors to initiate fibroplasia. Ultrasound is therapeutically effective AND
cost effective! US simply works better.
I would reference the work of Mary Dyson...you can find her work on
ultrasound....almost anywhere! Mary Dyson also authored a chapter in our
text book that I had the fortunate experience of co-editing. It is entitled
Wound Healing: Alternatives in Management, Second Edition, edited by
Jeffrey A. Feedar, PT, CWS, et. al. You can access information by looking
under the Books for Sale section at our web site located at
www.woundcareresources.com
This site also lists our continuing education seminars both in the US and
internationally. The next international location is in Seoul, Korea July 15
& 16, 2000.
You may want to take a few moments to glance at our "Wound Healing Myths"
section as well. You might find the myths "entertaining"! If you have any
quick questions regarding the use of Ultrasound, Electrical Stimulation,
Ultraviolet, etc., I would be happy to answer them ....time permitting.
Best Wishes,
Jeffrey A. Feedar, PT, CWS, Director
Wound Care Associates
(A Division of Wound Care Resources, Inc.)
180 Cherry Street
Williams Bay, Wisconsin 53191
USA
Web site: www.woundcareresources.com
Email: [log in to unmask]
phone: 1-262-245-6812
Electro v NSAIDS
I quite agree with some of these comments and would
like to add that in the appropriate cases (e.g. severe
mechanical injury like acute whiplash) I do not
believe ultrasound and NSAIDS to be of conflicting
interests. It is my understanding that, as stated
below, ultrasound is stimulatory to the inflammatory
cells and therefore their processes. The main role of
NSAIDS seems to be to dampen the activity/
effectiveness of the prostaglandin phase of the
inflammatory cascade (which of course is only one
aspect and obviously pain producing aspect of the
inflammatory process). It is my understanding that
this effect on the prostaglandins results in the local
blood vessels not being quite as "leaky" e.g. to the
escape of exudate into the connective tissue spaces -
thereby a reduction in oedema is achieved. We are
aware that the ice, compression, elevation regimes are
recommended and used to reduce the production of
excess oedema and I merely view NSAIDS as an adjunct
to this for acute mechanical injury. I do, however, do
this with caution as they are not necessarily
indicated or appropriate with a proportion of
patients.
Regards
Wendy Johnson
P.S. most of my information is from lectures and
articles by Dr. Tim Watson - in which he references a
number of eminent sources such as Mary Dyson (as
mentioned below)
Dear Nick and Wendy,
Let me qualify my first answer reprinted here:
"There are few benefits, IF ANY, of using NSAID's in a young healthy person
such as a soccer player who has suffered a mechanical wound. He is not
suffering from a disease, therefore I question the medical community's use
of theses drugs. These drugs may help in cases of systemic disease, but they
do more harm than good when used to treat mechanical injuries."
My answer did not say that the soccer player's injury was a severe one. I
should have qualified the injury. The "mechanical injury" referred to above
was not severe enough to produce an inflammatory response which in turn was
doing additional harm to the structures...rather the mechanical injury
referred to was an injury that normal inflammatory processes would occur and
would be enough to recover from the initial injury without the use of
NSAID's.
On the other hand, if a trauma was so severe that the resulting inflammation
was causing additional secondary damage then NSAID's may be appropriate!
The problem really is twofold.
1. The subjective evaluation of what is severe.
2. The overuse of drugs in general (the medical community prescribes drugs
far too easily!)
and NSAID's in this example.
Prostaglandin production sensitizes nerve endings and therefore
functionally serves as a guide to help limit function until enough repair
occurs. Prostaglandin production also serves to limit vessel leakiness
referred to above. These are facts and we are apparently in agreement with
these two points.
However, the ONLY time I believe NSAID's are necessary is:
1. when the pain from the injury is unbearable,
2. when the inflammation process is doing additional secondary harm,
3. when every minute counts to return to function, i.e., the highly paid
professional athlete.
I do not see a role for NSAID's if you, I or most of the population sprains
an ankle, suffers a contusion, etc. The body is quite capable of responding
to these "less than severe" injuries.
Something to think about....
We live on the great planet earth. We eat food, drink water, breathe in the
air and live under the influence of...energy. Energy from the sun, energy
from the electromagnetic spectrum, energy from........alot of sources. We
think certain thoughts....all of these affect our immune system and
therefore our repair processes. Our body is remarkable at utilizing the
energy from food and energy from the "place we live" to repair itself. There
are objective reasons why the "energy' modalities of ultrasound, electrical
stimulation, ultraviolet, hyperbaric oxygen, diathermy, even simple "hot
packs" and "magnets" work. They work better than most drugs.
Now don't get me wrong, I am not against pharmaceutical agents, thank
goodness for the drugs that work after the body's immune system failed to
"stop the germ". An excellent example is the duodenal ulcer that occurred
secondary to bacterial invasion. These ulcers are effectively treated with
antibiotics. The energy modalities listed above would be useless at stopping
the bacteria, (unless you could get ultraviolet in there!).
But in general, most wounds heal (especially wounds due to mechanical
injuries) because of the food we eat, the thoughts we think, where we live
and how we move around on the planet. Wounds heal because food energy
arrived at the cell "pushed" there by subtle energies. Wounds also "heal"
because of the time we give one another and the caring we give to one
another in far greater capacity than any "drug" ever will!
I am quite sure this answer will spark debate. I hope so! I thank you quite
sincerely for your time and your replies and I look forward to future
discussions...time permitting.
Jeffrey A. Feedar, PT, CWS
Wound Care Associates
(A Division of Wound Care Resources, Inc.)
180 Cherry Street
Williams Bay, Wisconsin 53191
USA
Web site: www.woundcareresources.com
Email: [log in to unmask]
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