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Short-Term NSAIDs Are Safe for Soft Tissue but Impair Bone Healing
Full Title
The effect of nonsteroidal anti-inflammatory drugs on tissue healing.
Summary
This critical review analyzed 44 studies to evaluate the effects of NSAIDs and COX-2 inhibitors on both soft tissue and bone healing. The review found that there is insufficient evidence of a detrimental effect when using either NSAIDs or COX-2 inhibitors at standard doses for 2 weeks or less on soft tissue healing. However, for soft tissue to bone healing, a limited number of studies did demonstrate impairment. With respect to bone healing, indomethacin showed a clear detrimental effect, with less substantial evidence for other NSAIDs. The study concludes that short-term, low-dose use of NSAIDs does not appear to harm soft tissue recovery following injury, but is inhibitory in cases where bone healing is required. This distinction is clinically important because it demonstrates that NSAIDs can be used selectively depending on the type of tissue being treated. For soft tissue injuries such as tendon, ligament, and muscle injuries, short-term NSAID use may be appropriate to manage inflammation. However, when bone healing is involved, such as fractures or spinal fusion, NSAIDs should be avoided. The review emphasizes that the prudent use of anti-inflammatory medications following sports medicine injuries is a reasonable option unless bone healing is a concern.