Natural Antiinflammatory Agents for Pain Relief in Athletes

Joseph C. Maroon, M.D.; Jeffrey W. Bost, P.A.-C.; Meghan K. Borden; Keith M. Lorenz; Nathan A. Ross

Disclosures

Neurosurg Focus. 2006;21(4) 

In This Article

Abstract and Introduction

Most athletes experience musculoskeletal injuries during their sports activity that require rest at a minimum, and occasionally injuries are severe enough to necessitate surgical repair. Neurosurgeons are often consulted for athletically sustained injuries and prescribe medications for the associated pain. The use of both over-the-counter and prescription nonsteroidal medications is frequently recommended, but recent safety concerns must now be considered. The authors discuss the biochemical pathways of nonsteroidal drugs and review the potentially serious side effects of these medications. They also review the use of natural supplements, which may be a safer, and often as effective, alternative treatment for pain relief.

Traumatic arthropathy, discogenic pain, posttraumatic headaches, tendonopathy, peripheral radiculopathy, and neuropathy are all conditions associated with participation in competitive sports.[24] Pain, heat, redness, and swelling (dolor, calor, rubor, tumor) from these injuries are part of the natural inflammatory process, which can lead to neurosurgical consultation.[108] With the elucidation of the role of inflammatory cytokines, we now understand the pathways by which many drugs can alleviate inflammation and hence pain. Among those inflammatory cytokines whose interactions with NSAIDs must be understood are IL-1α, IL-1β, and TNFα. These cytokines inhibit the production of prostaglandins, and therefore it is necessary to determine how they can be influenced by NSAIDs to develop an effective drug.[86]

Unfortunately, NSAIDs may be associated with significant complications, including the following: gastrointestinal hemorrhage, myocardial infarction, and stroke.[46,49,154] As a result of personal experience with these complications in our patients, including athletes, we investigated the use of natural antiinflammatory agents for neurological sports-related and other injuries. To our surprise, many such compounds are available and have been used effectively for centuries to reduce pain and inflammation. Additionally, we were able to find many peer-reviewed articles and clinical trials attesting to their effectiveness.

Recently the pharmacology of these agents relative to the COX and NF-κB inflammatory pathways has been elucidated.[86] In many cases the natural agents work in a similar biochemical fashion to pharmacologically derived drugs, but without the complications often associated with nonsteroidal medications. In this paper we summarize the current research on the inflammatory pathways, discuss the mechanism of action of various pharmacological and natural products in blocking inflammation, and provide an overview of the most commonly used natural antiinflammatory medications.

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