Why Painkillers Should Be Avoided For A Broken Bone

When I was very young my family lived next door to an elderly woman named Mrs. Russo who enjoyed working in her garden. One winter evening Mrs. Russo took a spill after an ice storm and fractured a bone in her leg. A few days later I overheard her say to my mother that she counted herself lucky because it could have been so much worse. By spring she was fine again and we kids often said hello to her when we saw her out watering and weeding her long rows of corn, tomatoes, zucchini and peppers.

Sometime the following year Mrs. Russo slipped on a wet floor. This time she wasn't so lucky; she broke her hip. After a long recovery she was able to get around fairly well with a cane, but her gardening days were over, and as I grew up I missed seeing her out working in her back yard.

I thought of Mrs. Russo when I came across a study about nonsteroidal anti-inflammatory drugs (NSAIDs). I have no idea what medications she might have taken to relieve the pain from those bad breaks, but if she resorted to NSAIDs use after her first fracture, she might have inadvertently contributed to her broken hip.

NSAIDs may impair healing

In several e-alerts and HSI Members Alerts we've told you how NSAIDs (such as aspirin, ibuprofen, and COX-2 inhibitors) have been shown to play a role in liver and kidney impairment, gastrointestinal problems, and even an increased risk of congestive heart failure. To that list we can now add: elevated risk of bone fracture.

In the Journal of the American Academy of Orthopaedic Surgeons, two US researchers from the University of North Carolina School of Medicine (UNC) reviewed several studies that examined the use of NSAIDs as analgesics for patients recovering from fractures.

One of the studies - as reported in the Journal of Bone Joint Surgery (2000) - compared the recovery of nearly 100 patients who had fractured a femur (the long bone that runs from the hip to the knee). The fractures of 32 subjects healed improperly and were classified as 'nonunion,' while fractures repaired correctly in a control group of 67 subjects.

The researchers found a significant association between the use of NSAIDs and the nonunion of fractures. More than 60 percent of the nonunion group reported regular NSAID use compared to only 13 percent in the control group. Among the subjects who used NSAIDs, the average healing time was a full two months longer than among those who didnt use them at all.

Based on this and other similar studies, the UNC researchers concluded that during the healing of fractures, NSAIDs should be avoided. They also noted that COX-2 inhibitors not only have an adverse effect on bone healing, but may also impair the healing of ligaments.

Pineapple pain relief

It's one thing for a researcher to crunch some numbers and recommend that NSAIDs not be used to manage fracture pain. But that same researcher might have a different opinion if he were to suddenly find his own femur in two pieces rather than one. The problem is, there aren't a lot of pain relief alternatives out there.

Acetaminophen (paracetamol) isn't an NSAID, and it can be an effective pain killer, but as I've mentioned in previous e-alerts, acetaminophen products can create health problems that are arguably worse than those of NSAIDs. Some of these health problems include liver and kidney impairment, as well as gastrointestinal conditions such as bleeding and ulcers.

A safe alternative to both acetaminophen and NSAIDs is a natural agent called bromelain. Bromelain is an enzyme found in pineapple, and it's been shown to reduce pain, inflammation, and swelling, AND help thin the blood as well.

Some people are allergic to bromelain, and ulcer patients should avoid using it. For most people, however, bromelain is free of side effects. A dose of 500 mg, taken three times each day, is typical for general pain management. But before starting a bromelain regimen, you should consult a doctor or healthcare professional who is knowledgeable about alternative medicine.

The meal factor

In most cases, supplements are absorbed most effectively when taken with meals. But bromelain is the exception to that rule. In the e-alert 'Bromelain: Natures painkiller' (2/8/05), I told you about an important bromelain tip from HSI Panellist Dr. Richard Cohan.

In an e-mail, Dr. Cohan wrote, 'I believe that it is important that you draw the distinction between bromelain's activity as a digestive aid when consumed with a meal, and its effectiveness as a pain modulator when consumed before a meal or three hours thereafter (depending how much fat was consumed and therefore how long digestive juices are present in the stomach). It apparently has no effect on pain when consumed with a meal.'