How does Ibuprofen work?
December 3, 2017 6:08 PM   Subscribe

I'm realizing I don't understand how basic pain relief works. So: can I use Ibuprofen before (activity that hurts my body) instead of waiting until the pain hits me?

Right now I'm regularly doing (physical activity) that hurts my (body part). I've discussed this with coaches, and it's basically unavoidable for the next few weeks/months as my body gets accustomed to the exercise and the specific requirements of this activity. I'm definitely not getting injured -- I'm just having some muscle soreness that goes away in a day or two...until I participate again. A few doses of Ibuprofen really helps.

So what would happen if I took the Ibuprofen...just before I do the activity? Does that stop the pain from happening at all? Or, directly after the activity, before I'm sore?

School me on how this sort of pain control works. Thanks.
posted by BlahLaLa to Health & Fitness (17 answers total) 5 users marked this as a favorite
 
I have taken ibuprofen before dental and medical procedures and it helps a little bit. Ibuprofen is an anti inflammatory so while it’s active in your system it will help reduce inflammation.

Also you didn’t ask but I prefer Robaxin over ibuprofen for post activity muscle soreness. It’s a very mild muscle relaxer. Unfortunately it’s by RX only in the US but I buy it over the counter every time I’m in Canada. It’s a life saver during ski season.
posted by joan_holloway at 6:20 PM on December 3, 2017 [1 favorite]


I’ve been having a flare-up of TMJ (gritting my teeth in my sleep) and was waking up every morning with vicious headaches until I started taking Aleve at bedtime. So in my experience, a prophylactic dose works.
posted by amro at 6:55 PM on December 3, 2017


(I realize Aleve does not equal ibuprofen.)
posted by amro at 6:57 PM on December 3, 2017


Taking ibuprofen before you work out is a thing that people do. It is common and it is controversial. A quick Duck Duck Duck search yields many articles, for example Ibuprofen Before Exercise?
posted by Winnie the Proust at 7:03 PM on December 3, 2017 [2 favorites]


So just to answer the direct question: yes, you can take NSAIDs before the pain starts and it helps stave off pain. This has been recommend to me by doctors both for various procedures (e.g. dental work) and for menstrual cramps.

However, as Winnie points out there may be reasons you don't want to do this especially before working out.

It's probably a good idea to consult the doctors you've already spoken to to ask if they recommend taking it before working out, after working out but before pain starts, or after pain starts, and to ask about their recommended dosage.
posted by brainmouse at 7:13 PM on December 3, 2017 [1 favorite]


Ibuprofen, like other non-steroidal anti-inflammatory drugs (NSAIDs), is thought to reduce inflammation and pain by inhibiting the cyclooxygenase (COX) isoenzymes, including COX-1 and COX-2. These enzymes are involved in the synthesis of prostaglandins, which have wide-ranging effects in the human body, the most relevant of which for discussing the mechanism of action of ibuprofen, are maintaining the integrity of the gastrointestinal mucosal lining, mediation of platelet aggregation, mediating vasodilation (including vasodilation that is key to maintaining kidney function), and mediating pain and inflammation.

Inhibiting COX-1 isoenzymes has little to no effect on the prostaglandins involved in pain, but exerts some cardioprotective antiplatelet effects and over time may disrupt the stomach lining and gastrointestinal lining, potentially resulting in NSAID-associated gastropathy. Inhibition of COX-2 isoenzymes disrupts the formation of prostaglandins that mediate pain, but also reduces formation of vasoactive eicosanoids. A lack of vasodilatory mediators increases cardiac risk. Vasodilatory prostaglandins also help maintain the pressure gradient of the nephron (COX-2 is predominantly involved in synthesis of prostaglandins involved in kidney function). Keep in mind that this is the general theoretical framework of understanding NSAID pharmacology. The reality is probably more complex.

Each NSAID has ratio of COX-2 to COX-1 selectivity at a given concentration. Because this ratio changes with the NSAID concentration in blood (determined by the dose taken), it is more useful to talk about the concentration of an NSAID at which 50% of COX-1 and 50% of COX-2 isoenzymes are functional, or the 50% inhibitory concentration (IC50). The ratio of IC50 values for COX-1 and COX-2 for ibuprofen is 0.5 and for naproxen is 0.7. This ratio qualifies these OTC medications as nonselective. Nonselective US prescription NSAIDs also have a relatively low value for COX-1 to COX-2 IC50 values; for indomethacin, the ratio is 1.9, for example. The ratio for medications like diclofenac (29), celecoxib (30), and the now-withdrawn rofecoxib (267) makes them more selective for COX-2, and in theory less likely to cause gastric damage, and potentially more likely to cause cardiac events.

This is all theoretical, however. What actually determines the ratio of COX-2 to COX-1 inhibition is the dose administered. High-dose NSAIDs, then, will be less selective for COX-2 and high doses are more likely to cause gastrointestinal, cardiovascular, and renal events. This is important, because in the PRECISION trial, at the doses typically used therapeutically for rheumatoid arthritis and osteoarthritis, celecoxib was no more likely to cause cardiovascular events or cardiovascular death than nonselective NSAIDs (ibuprofen or naproxen). A post hoc analysis of including just patents who stayed on treatment (not the intent-to-treat population) seemed to show less risk of gastointestinal and in some analyses renal adverse events with celecoxib.

I am not your doctor, but I would note 2 things:
1) As a former competitive runner, I saw people taking ibuprofen before exercise and it might have some small short-term benefits, but might mask symptoms and increase the risk of injury. Listen to your body.
2) There is some evidence that the decreased gastrointestinal blood flow during exercise greatly increases the risk of gastric adverse events. In 2011, Olivera et al wrote, "Blood flow to central tissues (gut and liver) is reduced during exercise by almost 80%, at 70% of VO2max." The same year, Van Wijk (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141050/) found that gut permeability was increased during exercise. In 2012, the same group tested ibuprofen before aerobic exercise and found significantly greater gut barrier dysfunction in exercisers, and concluded, "This is the first study to reveal that ibuprofen aggravates exercise-induced small intestinal injury and induces gut barrier dysfunction in healthy individuals. We conclude that nonsteroidal anti-inflammatory drugs consumption by athletes is not harmless and should be discouraged."

The last 3 words of that are probably the best advice on this issue from the current research.
posted by candasartan at 7:33 PM on December 3, 2017 [68 favorites]


In certain strength training circles, ibuprofen is referred to as "vitamin I" and commonly taken as a supplement.
posted by turbid dahlia at 8:24 PM on December 3, 2017 [1 favorite]


I wonder if anyone can comment on the mechanism by which muscle becomes augmented, and whether inhibiting the inflammation after exercise (by use of NSAIDs) would inhibit that growth.
posted by amtho at 8:32 PM on December 3, 2017




If we're just talking about normal post-exercise soreness eg DOMS and you're sure you're not getting injured, no, I wouldn't take ibuprofen for that at all. I've also seen studies that suggest NSAIDs may inhibit muscle growth/repair.

Massage and light cardio will help with the pain.
posted by missmagenta at 2:07 AM on December 4, 2017


A personal example, when skiing infrequently I had one leg muscle that just got so painful I'd need to stop and to get through the day a strong dose of Ibuprofen before the afternoon session worked well. But that was just a few days in a year.
posted by sammyo at 4:00 AM on December 4, 2017


If you're getting bad DOMS rather than feeling injured in some way, make sure you get plenty of protein straight after (exercise thing), ideally within 30 mins of finishing. I find drinking a glass of milk or eating natural yoghurt great for this. You might not need the Ibuprofen then!
posted by london explorer girl at 7:07 AM on December 4, 2017


Take the gastro bleed warnings seriously. I have to take several regular meds (including an NSAID) that cause associated bleeding, and have had one stomach bleeding episode already which was So Not Fun - pain, cramps, bloating and more pain. Spitting up blood is a lot less exciting than Moulin Rouge made it look. Ibuprofen is something you take as a very occasional treatment for pain, not a regular medication if you can avoid it.
posted by dorothyisunderwood at 7:14 AM on December 4, 2017 [1 favorite]


Depending on the body part, you may be able to use Voltaren gel to get benefit of NSAID without GI issue.
posted by crazycanuck at 8:01 AM on December 4, 2017



Depending on the body part, you may be able to use Voltaren gel to get benefit of NSAID without GI issue.


You will alleviate the primary insult of adding an acid to the stomach and GI tract, but you will still need to take care as inhibition of prostoglandin synthesis can also inhibit protective effects on the stomach lining.

My dad gave himself a bleeding ulcer by taking ibuprofen for years (when he really should have been getting his knee fixed) so while NSAIDs are fine for short term pain relief if you are thinking of taking them with regularity be sure to see a doctor (or actually understand what the underlying causes of the pain are and fix those instead)
posted by koolkat at 8:13 AM on December 4, 2017


Thank you very much for the responses. I'll hold off for now and see if I can just power through the next few weeks until my (body part) gets accustomed to the demands of this particular exercise.
posted by BlahLaLa at 10:32 AM on December 4, 2017


joan_holloway: "Also you didn’t ask but I prefer Robaxin over ibuprofen for post activity muscle soreness. It’s a very mild muscle relaxer. Unfortunately it’s by RX only in the US but I buy it over the counter every time I’m in Canada. It’s a life saver during ski season."

Note that in Canada the muscle relaxer ingredient is also available generically in combination with ibuprofen or aspirin rather than acetaminophen as in robaxin.
posted by Mitheral at 10:40 AM on December 4, 2017


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