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Nonsteroidal Antiinflammatory Drugs in Tendinopathy: Friend or Foe

Authors: M Magra; N Maffulli

References: Clin J of Sport Med: 16(1) January 2006 pp 1-3

Abstract
Pharmacologic management strategies for tendinopathies vary considerably, and are frequently based on empirical evidence. Can the continued use of NSAIDs for the treatment of tendinopathies be justified? The available literature would suggest that in the absence of an overt inflammatory process, there is no rational basis for the use of NSAIDs in chronic tendinopathy, because they are unlikely to change its still ill-defined natural history. Despite this reality, many clinicians still anticipate a quicker and better recovery using these agents. There is no biologic basis for NSAID effectiveness in treating this condition, and no evidence of any benefit. NSAIDs appear to be effective, to some extent, for pain control. This causes patients to ignore early symptoms, and thus may lead to further damage of the tendon and delay definitive healing. Early NSAIDs administration after an injury may have a deleterious effect on long-term tendon healing. It would thus seem reasonable to shift our research efforts to other forms of conservative management. Examining strategies that promote the migration and activation of tenocytes to influence tendon healing and function might be an appropriate first step. It is equally appropriate to limit our use of NSAIDs in the management of tendinopathy. What may appear clinically as an acute tendinopathy is actually a well-advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation.

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