NSAIDs increase the risk of potentially fatal, stomach and intestinal adverse reactions (for example, bleeding, ulcers, and perforation of the stomach or intestines ). These events can occur at any time during treatment and without warning symptoms. Elderly patients are at greater risk for these adverse events. NSAIDs (except low dose aspirin) may increase the risk of potentially fatal heart attacks, stroke , and related conditions. This risk may increase with duration of use and in patients who have underlying risk factors for heart and blood vessel disease. Therefore, NSAIDs should not be used for the treatment of pain resulting from coronary artery bypass graft ( CABG ) surgery.
However, it should be remembered that the inflammatory or 'lag phase' is the first stage of the healing process and a degree of pain and loss of function may be helpful to prevent the athlete doing further damage to the injured part. The question of whether NSAIDs have an adverse effect on healing was examined by Obremsky et al (1994) and Almekinders (1986). Both studies showed no significant effect on tensile strength recovery following NSAID treatment for muscle strain injury, and Obremsky et al (1994) further demonstrated that muscular force was also unaltered. However, both studies showed histologic evidence of delayed healing with NSAID use, although it should be stated that both studies utilised animal models.
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