Do pain relievers heal tendinitis, or just ease pain?

Nonsteroidal anti-inflammatory drugs, or Nsaids, such as ibuprofen, are commonly given to blunt the pain and inflammation of tendinitis. But most physicians now believe that tendinitis – the suffix “itis” means inflamed – is misnamed, since the condition may involve little or no inflammation.

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Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis, Pfeffer G, Bacchetti P, et al.

by Gretchen Reynolds, The New York Times April 8, 2016

In recent years, scientists have examined biopsies from both people and animals with supposed tendinitis and found few if any signs of inflammation in the tendons, the tissues that connect muscles to bones. Immune cells associated with inflammation have not been present, and genes known to cause inflammation have not been active.

So today, most researchers prefer the term “tendinopathy,” meaning damaged or degenerating tendon.

This distinction matters, because Nsaids are anti-inflammatory drugs. If tendinopathies involve little inflammation, then anti-inflammatory drugs will provide little relief – though it is possible that Nsaids may blunt pain because they are also potent analgesics.

But even then, the benefits of Nsaids seem equivocal. In a recent study of treatments for rotator cuff tendinopathy, scientists reported that Nsaids lessened people’s soreness, but the effects were short-lived and did not improve shoulder function. Perhaps more worrying, animal studies suggest that rather than contributing to healing, Nsaids may actually slow healing.

“Nsaids work by inhibiting the production of prostaglandins,” said Stuart Warden, a professor of health science at Indiana University who has studied tendinopathy and Nsaids. Prostaglandins are involved in pain but also in the creation of collagen, a substance that aids in tissue healing, he said. Less collagen is thought to mean slower healing of injuries. So swallowing Nsaids is likely to delay recovery from a tendinopathy.

On the other hand, a trip to the gym may help. Some studies have found that light weight-training encourages healing of sore tendons. In one useful recent experiment, for instance, people with plantar fasciitis, a tendinopathy of the foot, reported much less pain after a few months of an exercise involving standing on a step or box and lowering their affected heel while wearing a weighted backpack. Consult a doctor or physical therapist, of course, before starting any exercise program.

Source The New York Times