Pain medications found to impair healing in shoulder surgery

06/20/04

Study shows NSAIDS & COX-2 slow healing

New York, NY, June 25, 2004 Preliminary research in a study of small laboratory animals suggests that widely prescribed pain medications may possibly delay healing in rotator cuff repair, a common shoulder operation, according to a new study by a team of doctors at the Hospital for Special Surgery. Close to two million people in the United States seek medical care each year for rotator cuff problems and the use of pain medications is standard post-operative procedure.

The researchers will present their data on June 25 at the meeting of the American Orthopaedic Society for Sports Medicine in Quebec City, at which time they will also receive the Society's "Excellence in Research Award" for their efforts.

The research involved 180 laboratory rats that underwent acute rotator cuff repair surgery. One-third of the rats were treated with indomethacin, a widely prescribed and effective pain medicine that is part of the category of drugs known as nonsteroidal anti-inflammatory medications (NSAIDs). Another 60 rats were treated with celecoxib, a member of a newer class of FDA approved pain medications known as COX-2 inhibitors. The remaining 60 rats were given standard rat chow.

The investigators found that the tendon to bone healing in the rats treated with the two drugs was "distinctly less robust" than in the control groups. Five tendons completely failed to heal to bone after 4- and 8-week time periods, but "no tendons in the control group failed to heal."

The rotator cuff is composed of the muscles and tendons that surround the top of the upper arm bone (humerus) and hold it to the shoulder joint. Rotator cuff injury is common in people over age 40. Doctors at the Hospital for Special Surgery performed just under 500 rotator cuff repair surgeries in 2003.

"This is a preliminary study, but our findings provide reason for concern and for additional studies in larger animals. Our hypothesis involving tendon to bone healing is based on well-documented studies that have shown that although NSAIDs are effective pain relievers, they have also been shown to negatively affect fracture healing and spinal fusions, and may have adverse effects on ligament healing," said Scott A. Rodeo, M.D., an orthopedic surgeon and sports medicine specialist at the Hospital for Special Surgery.

More than 33 million Americans regularly take over-the-counter and prescription NSAIDs to reduce pain. Another 7 million Americans take COX-2 inhibitor medicines to relieve pain and inflammation.

Co-authors from the Hospital for Special Surgery Cornell University Medical Center team include David Cohen, MD; Sumito Kawamura, MD and John Ehtshami, MD.

Source: Eurekalert & others

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