Anti-inflammatory Drugs May Do More Harm than Good in Tendinopathy

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Ibuprofen, naproxen, and related “nonsteroidal anti-inflammatory drugs” (NSAIDs) don’t help and might even hinder healing in patients with tendon conditions known as tendinopathy, according to an editorial in the January/February Clinical Journal of Sport Medicine.

Tendinopathy is not an inflammatory problem, so there is no “biologic basis” for using NSAIDs to treatment this condition, write Drs. Merzesh Magra and Nicola Maffulli of Keele University School of Medicine, Staffordshire, U.K.

Drs. Magra and Maffulli review current knowledge of tendinopathy and its treatment. “Tendinopathy” is a general term describing tendon problems, generally related to overuse. 

Common in athletes-but sometimes occurring even in inactive people-tendinopathy may affect tendons in many different joints. Frequent sites include the Achilles tendon, the elbow tendons ("tennis elbow"), and the rotator cuff tendons in the shoulder.

Although many of these conditions are referred to as “tendinitis,” the name is inaccurate. The suffix “-itis” means inflammation, but studies have shown that inflammation isn’t really present in chronic tendinopathy. Inflammation may be part of the process by which the pain, stiffness, and other symptoms become established. However, it’s not part of the poor healing characteristic of chronic tendinopathy.

Previous clinical trials have found no effect of NSAIDs such as ibuprofen or naproxen in promoting tendon healing in athletes with tendinopathy. Nevertheless, NSAIDs are widely recommended for patients with various types of tendinopathy.

NSAIDs are effective in reducing pain. Ironically, this could allow patients to ignore early symptoms, potentially leading to further tendon problems and delaying definitive healing.

The authors urge research aimed at other treatments to promote true tendon repair, perhaps including strategies to promote the migration and activation of tendon cells. Meanwhile, “It is equally important to limit our use of NSAIDs,” Drs. Magra and Maffulli conclude. “From our understanding of the etiology and development of this condition, we believe that there is no scientific basis to manage chronic tendinopathy with NSAIDs.”

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