When to Take Pain Meds (and When to Hold Off)

Welcome to The Movement. [6-minute read]

Hi there, and welcome to my newsletter.

My name’s Ryan, and I specialize in helping people be active and thrive in and out of the gym. This newsletter is about challenging the status quo of healthcare and fitness and summarizes what I’m learning, thinking, and teaching.

Thanks for reading and being a part of The Movement.

Here’s what we got this week.

Should we be using NSAIDS?

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, acetaminophen, naproxen, and aspirin aren’t going anywhere.

We know better alternatives to pain relief exist, but does that mean we should NEVER be using NSAIDs?

Or, are there certain instances when they actually make the most sense?

We should first understand that NSAIDs aren’t necessarily "painkillers."

They reduce inflammation, which in turn lowers pain signals from the injury.

When you get injured, the affected area becomes sensitized, sending signals to your brain to protect it. NSAIDs reduce this sensitization, helping you feel less pain.

Inflammation is part of the natural healing process. Without it, we can’t kickstart the repair.

Think of it like this - inflammation is like your body’s emergency response team. When you get hurt, it rushes in with repair crews (cells, nutrients, hormones) to start the healing process. Pop an NSAID, and you're telling those workers to take a break. Less pain, but slower healing. Sometimes, you need a little chaos to rebuild stronger. Newer research suggests that blocking inflammation with NSAIDs might actually slow down the normal healing process, especially in cases like fractures and broken bones.

And since pain is highly subjective, how do you know when it’s right to intervene with medication?

A good rule of thumb: If pain keeps you from performing your daily activities to your usual standard, it might be time to consider taking an NSAID.

But be careful. Using NSAIDs to dull the pain might lead you to misuse the injured area, potentially causing more damage.

There’s a balance to strike: Dull the pain too much and you risk injury; avoid NSAIDs altogether and you might not get the rest needed for recovery.

Another general rule of thumb is if the pain is keeping you from sleeping, taking the lowest dose of an NSAID helps you rest. Sleep is crucial for healing and next-day function and overall recovery and so whatever we gotta do to get that shuteye we gotta do it.

Not all NSAIDs work the same for everyone. It’s worth trying a few different ones to see which offers the best relief with the least side effects.

Aspirin has different effects at different doses. A baby aspirin (81 mg) works as an antiplatelet, while a full dose (325 mg) acts as an anti-inflammatory.

What about in the performance realm?

There’s a lot of “running influencers” touting the benefits of Advil (ibuprofen) for endurance performance, pain relief, and recovery.

But generally speaking, NSAIDs are not helpful for runners. On the contrary, they’re probably detrimental.

Impact on Endurance Performance

Studies consistently show that NSAIDs do not enhance endurance or exercise performance. A 2020 meta-analysis found no significant effect on maximum performance or time until exhaustion in healthy individuals. Similarly, a 2015 study on male long-distance runners showed ibuprofen did not improve running performance after muscle damage.

This suggests runners may not gain performance benefits, and there’s a trend toward reduced self-perceived pain without clear physiological improvement.

Health Risks, Particularly Kidney Function

NSAIDs pose risks to kidney function, particularly in endurance runners. Research highlights a potential link to AKI, especially in ultramarathons. A 2024 scoping review noted mixed results but suggested NSAIDs might increase AKI risk, with one trial showing 22 of 42 ibuprofen users developing AKI compared to 16 of 47 on placebo.

Environmental conditions like heat and dehydration can worsen these risks, as NSAIDs may impair kidney water and sodium regulation, increasing vulnerability in hot, humid races.

Effects on Exercise Adaptations

NSAIDs may interfere with exercise adaptations, such as bone density and muscle growth. A 2010 study found that ibuprofen use before exercise reduced improvements in bone mineral density (BMD) in premenopausal women. Other studies suggest NSAIDs might hinder muscle protein synthesis, potentially affecting long-term endurance adaptations, though evidence is mixed. This is an unexpected detail, as many runners might not realize NSAIDs could impact their body’s ability to adapt to training over time.

Overall, research suggests NSAIDs like ibuprofen may not improve endurance or exercise performance and could increase acute kidney injury (AKI) risk in runners, especially in hot, dehydrating conditions.

Also, it seems likely that NSAIDs can negatively affect long-term exercise adaptations, such as bone density and muscle protein synthesis, with mixed evidence on the extent.

The evidence leans toward caution for runners, with potential risks to kidney function and adaptations, though findings vary across studies and conditions.

10009/Bottom line: NSAIDs have their place, but they’re not a long-term solution. Use them wisely and stay mindful of how they affect your healing process and overall health.

Until next time

That’s all for today. Whenever you’re ready, here’s how I can help.

• 🤝 Want to work with me 1:1? Book a Discovery Call to see if you’re a good fit.

• 💊 Looking for top supplements? Access my recommended selections through Fullscript, my online dispensary.

• 📕 Curious about managing pain? Download my “Pain Guide” here.

Need something else? Just reply to this email - read every response.

Share it

Thanks for being here and taking the time to read this.

If you’ve enjoyed this volume of The Movement, please spread the love and tell your friends! You can share this newsletter using the link below:

https://the-movement.beehiiv.com/subscribe

Do you have any suggestions for The Movement? Reply directly to this email or shoot me a message on Instagram.

See yah out there,

Ryan

DISCLAIMER: This newsletter is for educational and informational purposes only and is not intended as a substitute for professional medical advice.