NSAIDS prevent bone fussion??

[Crystal]

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I would like to know if anyone has heard of NSAIDs preventing bone fussion.

My BF's mother had spinal fussion surgery and was taking percocet. About a week out she was still having alot of pain and taking a ton of percocet. Her surgeon was on vacation. I recommended she take ibuprofen, assuming some of the pain was related to the inflammation. However, when she called the office an RN told her she could not take NSAIDs b/c they might decrease the success of bone fussion.

I had never heard of such a thing so I did some research. It seems that there is a very large mix of evidence and opinions out there. Does anyone have any experience with this? Do you know of any LARGE randomized controlled studies that have looked into this? Thanks. -C

 

[twester]

I couldn't find any large studies done with ibuprofen following spinal fusion. I did a PubMed search and it seems that NSAIDs are overwhelmingly discouraged in the early post-op period.

Is there some reason why you don't want to take the advice you were given? Throwing ibuprofen at that kind of pain is like shooting an elephant with a BB gun.

 

[Crystal]

Thanks for the advice... but my question is not whether or not she should be taking this med, if it is against the surgeons advice then I wouldnt encourage. My question, as a clinical pharmacist and a person seeking knowledge, is where are the trials supporting this claim and what is the proposed mechanism of action? If NSAIDs prevent bone fussion, should be be allowing patients with broken bones to take them for pain relief? And which NSAIDs are better than others in this situation, if any? The only solid articles I have found specifically site high dose ketorolac

 

[twester]

As a clinical pharmacist, you must have access to PubMed or another journal database. Do a search and follow the links (especially the links that follow references). You'll come to an MOA for prostaglandins and their role in bone formation. It follows that COX inhibitors will affect that process.

Here's a starting point for you:

Dumont AS, Verma S, Dumont RJ, Hurlbert RJ. Nonsteroidal anti-inflammatory drugs and bone metabolism in spinal fusion surgery. Journal of Pharmacological and Toxicological Methods 2000 Feb; 43(1): 31-39.

Good luck.

 

[sdn1977]

Crystal....the problem we have in answering this question more specifically is you're asking for individual medical advice.....which the TOS specifically prohibit.

We cannot address your question anymore specifically because of that. However, if you ever want to post a similar question - don't preface it with a reference to a specific individual.

Now....for orthopedic surgery....there could be many reasons why an NSAID could be contraindicated & since we don't know the specifics, we can't speculate. But...they are often not used in the post operative orthopedic period.

Remember also.....the "office staff" of the physician may know the physician does not want a particular treatment, but may have confused the reason why, so they may have told your friend's mom something without having the reason correct.

Likewise....be careful giving advice when the pt is not YOUR pt. A week out from back surgery is not too long to be on narcotics...so its worth waiting for the surgeon to return & having her speak to him on her postoperative visit regarding her pain control & rehabilitation.

Best of luck to her!

 

[BMBiology]

A few animal studies show continous use of an NSAID can interfere with bone healing. However, this has not been proven in humans. Just to be safe, you should advise her not to use an NSAID several weeks after the surgery. Short term use is however reversible when it is discontinued.

You should also let her know smoking and drinking alcohol can also delay bone healing.

Wheeler P, Batt ME. Do non-steroidal anti-inflammatory drugs adversely affect stress fracture healing? A short review. Br J Sports Med 2005;39:65.

 

[bananaface]

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