Painkillers may slow healing after shoulder surgery

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Painkillers may slow healing after shoulder surgery

Last Updated: 2004-06-25 12:48:00 -0400 (Reuters Health)

By Merritt McKinney

NEW YORK (Reuters Health) - Anti-inflammatory drugs commonly used to

relieve pain after shoulder surgery may impair healing, new animal

research suggests.

Rats that were treated with anti-inflammatory drugs had poorer healing

than animals that were not given the drugs, researchers reported Friday

at a meeting of the American Orthopaedic Society for Sports Medicine in

Quebec City, Canada.

The findings " should give us pause " about the use of anti-inflammatory

drugs in people who have rotator cuff surgery, study investigator Dr.

A. Rodeo of the Hospital for Special Surgery in New York told

Reuters Health in an interview.

But Rodeo cautioned that more research is needed to confirm the results.

" At this point, we can't make recommendations " about the use of

anti-inflammatory drugs after rotator cuff surgery,

If the findings are confirmed, Rodeo said it may be wise to avoid giving

the drugs to patients who are likely to have problems healing after

shoulder surgery, including the elderly, people with the brittle-bone

disease osteoporosis and people who are having repeat surgery.

Rodeo and his colleagues tested the effect on healing of drugs called

nonsteroidal anti-inflammatory drugs, or NSAIDs. This class of drugs

includes over-the-counter pain relievers such as ibuprofen, aspirin and

naproxen, as well as the newer prescription drugs celecoxib (Celebrex)

and rofecoxib (Vioxx).

NSAIDs are often used to relieve pain after surgery to repair the

rotator cuff, which is made up of the muscles and tendons that hold the

upper arm bone to the shoulder.

Previous research has shown that NSAIDs have a negative effect on bone

formation, Rodeo said. Because healing after rotator cuff surgery

involves bone formation -- bone grows into the outer tendon -- Rodeo and

his colleagues set out to see whether NSAIDs affect healing after the

shoulder surgery.

Anti-inflammatory drugs " really did have an adverse effect in this

model, " Rodeo said.

Rodeo's team found that rats treated with the NSAIDs celecoxib or

indomethacin after surgery experienced poorer healing than animals that

did not receive any anti-inflammatory medication.

Among the 120 rats treated with one of the drugs, five tendons failed to

heal at all. None of the tendons in rats that did not receive the drugs

failed to heal.

This is the first study to suggest that anti-inflammatory medications

impair healing after rotator cuff surgery, Rodeo said.

But the New York researcher cautioned that the findings need to be

confirmed in a study involving larger animals, such as sheep, as well as

in human trials before changes are made in clinical practice.

Still, Rodeo cautioned, " there is the potential for adverse effects. "

If future studies bear out the findings, Rodeo said that there are other

options for relieving pain after shoulder surgery, including narcotic

pain medications. Unfortunately, narcotics can be addictive and may

cause side effects, including constipation and nausea, Rodeo said.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org