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Sports medicine professionals and others in the medical world continue to voice their concerns about the use of prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) and over-the-counter (OTC) painkillers, many of which contain acetaminophen. According to the Centers for Disease Control and Prevention (CDC), women take NSAIDs more frequently and in higher doses than men—and, according to a 10-year span of data, more women than men logged a trip to the emergency room as a result of negative painkiller events or died from a prescription painkiller overdose. As women have increased their participation in athletics and other fitness endeavors, they have pushed their use of painkillers outside the realm of normal everyday aches and pains.
It’s imperative to have a cool-down period following a tough workout; the body is a network of deeply interconnected systems, all of which are impacted to various degrees by training. However, taking NSAIDs after exercise reduces the production of muscle satellite cells; these cells form in response to resistance training and connect with existing muscle fibers to form new lean muscle tissue. According to Michael Loes, MD, author of Healing Sports Injuries Naturally, 95 percent of sports injuries are minor traumas involving soft tissues—think sprains, strains, contusions, or bruising—which result in inflammation and pain. In addition, recovery efforts may be made worse by a “wind-up phenomenon” in which pain signals are amplified, explains Mellisa Stoppler, MD, PhD.
A recent study published in Nature Reviews Neuroscience suggests that chronic pain affects the anatomy of the brain and impairs certain nerve pathways, leading to a negative feedback loop that prevents the brain from releasing its own natural painkillers.
The bottom line is that focusing only on relieving pain before and after a workout—without emphasizing long-term healing—literally intensifies pain signals in the body that, in some cases, may be false alarms.
Nearly half of the people who overdose on acetaminophen, the active ingredient in many NSAIDs, do so unintentionally, says Jay S.
Many people who accidentally overdose may not feel the effects in one single dose; however, medical researchers refer to this as a “staggered overdose,” which elicits damage with time (such as liver failure) and initiates the need for a liver transplant. It’s a misconception that NSAIDs are only cautioned in patients with existing heart disease—even short-term treatment with most NSAIDs is associated with an increased risk of death. Both alcohol consumption and fasting (due to illness, eating disorders like anorexia, or malnutrition) greatly increase the risk of liver injury after ingesting acetaminophen.
Forward-thinking medical professionals have petitioned the FDA to include an insert to alert NSAID users about the benefits of NAC, however to no avail. It is preferable to target the underlying cause of pain when considering your treatment options—and then choose the option that will best promote your healing. In the world of fitness and bodybuilding, the goal is to reduce body fat and become stronger.
Although not on the top of the list for discussions around the water cooler, a number of non-medical protocols definitively reduce pain; unfortunately, in many cases, they are mere afterthoughts. From herbs that attack inflammation to techniques that leverage the brain's remarkable healing powers, nature offers many treatments for conditions such as arthritis, fibromyalgia, and even muscle strains.
Here are eight natural remedies that may enhance or replace conventional antidotes, and leave you happier, healthier, and pain free.
What the science says: Both supplement brands contain ginger, turmeric, and holy basil, all of which have anti-inflammatory properties. How to try it: Use homeopathic arnica as an adjunct to ice, herbs, or conventional pain meds, suggests Guiltinan.
How to try it: Marigot recommends 2,400 mg a day (two capsules) of Aquamin in tablet form, sold domestically in products such as Aquamin Sea Minerals and Cal-Sea-Um. Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. What the science says: SAM-e is made from a naturally occurring amino acid and sold as capsules. Studies by the University of Maryland School of Nursing and the University of California, Irvine, showed that SAM-e was as effective as some NSAIDs in easing osteoarthritis aches; the California researchers found that SAM-e quashed pain by 50 percent after 2 months, though it took a few weeks to kick in. Also, inspect the packaging before buying, advises Gregory: Make sure the product carries a USP or GMP quality seal, contains a stabilizing salt, has a far-off expiration date, and comes in foil blister packs — SAM-e can degrade rapidly in direct light. What the science says: Digested fish oil breaks down into hormonelike chemicals called prostaglandins, which reduce inflammation. How to try it: Taking 1,000 mg is proven to help your heart, but you should up the dose for pain.
What the science says: MSM is derived from sulfur and may prevent joint and cartilage degeneration, say University of California, San Diego, scientists. What the science says: Patients who counted backward from 100 out loud during an injection experienced and recalled less pain, according to a recent Japanese study.

A recent study found that individuals who are well-trained in the  Zen meditation practice appear to be less sensitive to moderate pain.
Researchers studied individuals who were healthy and who were already experienced in meditation. The longer the amount of time that study participants had been practicing meditation, the more the meditative state allowed them freedom from pain. Researchers believed that the combination of relaxation and concentration achieved by those who meditate was what enabled them to get through the experiments without registering pain.
Previous studies have suggested that meditation techniques might allow the release of endorphins, chemicals in the body known to help relieve pain. It seems clear that learning to relax, particularly in the face of pain or painful medical procedures, may be an effective tool for managing pain, good news for those who face chronic pain and are seeking non-drug alternatives. For reasons unknown, research has shown that women are more likely to have chronic pain, be prescribed prescription painkillers, be given higher doses, and use them longer than men. Researchers contend that many athletes take NSAIDs before every workout or competition; however, studies indicate that taking these drugs before a workout can increase the side effects typically seen in heavy users. Rest and recovery gives muscles, joints, the brain, and all our internal communication systems the time to heal while allowing the nervous system to calm down.
Lean muscle is a key player in not only healing damaged muscle tissue, but also stimulating our metabolism. He explains that taking a drug like ibuprofen actually activates pro-inflammatory chemicals called prostaglandins, which encourages sub-acute inflammation on top of the normal discomfort that can persist up to four weeks—or longer.
Nerve fibers like muscle tissue get stronger with exercise, which means they become more efficient at transmitting signals to the brain—effectively amplifying pain signals even in cases of slight injury. A study in the American Journal of Emergency Medicine revealed that when doctors prescribed acetaminophen-narcotic combination pain medications to patients, they didn’t warn the patients about other medications containing acetaminophen that they should reduce or discontinue. Using acetaminophen-based products as quick remedies for ailments such as toothaches, headaches, back and joint problems, and a cold or flu contributes to this staggered buildup. In addition, many doctors already exercise caution when considering NSAIDs for the relief of chronic pain because these drugs increase the risk of ulcers and serious bleeding in the stomach and gastrointestinal tract. Fasting decreases levels of glutathione, the most abundant and powerful internal antioxidant naturally present in the body. NSAIDs actually kill off the body’s supply of NAC, which is why people who overdose on the drugs are given large doses of NAC when they are brought to the emergency room.
Fortunately, NAC can be purchased at your local vitamin store—but be sure to read labels and choose a trusted brand. Loes discovered that adding enzymes that break down protein—such as bromelain, derived from pineapple, and papain, derived from the papaya plant—to post-workout formulas accelerated muscle recovery and greatly reduced inflammatory chemicals that cause pain and swelling. For this reason, sports medicine researchers and even body builders recommend taking a multiple enzyme before and after workouts. However, in the process, you shouldn’t confuse pain relief with rebuilding and regeneration of muscle—because this is what will prevent you from reaching that next fitness level. For example, simple stress reduction techniques like acupuncture, hypnosis, meditation, music therapy, relaxation therapy, yoga, and guided imagery may provide relief. Nonsteroidal anti-inflammatory drugs, or NSAIDs, don't agree with your stomach, and you're wary of stronger meds. From herbs that attack inflammation to techniques that leverage the brain's remarkable healing powers, nature offers many treatments for conditions such as arthritis, fibromyalgia, and even muscle strains.
Nearly 40 percent of arthritis patients reduced their pain by half after using a topical capsaicin cream for a month, and 60 percent of neuropathy patients achieved the same after 2 months, according to a University of Oxford study.
Turmeric (a curry ingredient) may be the best: A component, curcumin, eases inflammatory conditions like rheumatoid arthritis and psoriasis, according to the Methodist Research Institute in Indianapolis.
Taking oral homeopathic arnica after a tonsillectomy decreases pain, say British researchers, and German doctors found that it reduces surgery-related knee swelling.
Rub arnica ointment on bruises or strained muscles, or take it in the form of three lactose pellets under the tongue up to six times per day. A preliminary clinical study showed that the ingredients may reduce joint inflammation or even help build bone, says David O'Leary of Marigot, Aquamin's Irish manufacturer.
But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Doctors aren't entirely sure why it tamps down pain, but it reduces inflammation and may increase the feel-good brain chemicals serotonin and dopamine.
SAM-e produced no cardiovascular risks and fewer stomach problems than the conventional meds.
In one study, about 40 percent of rheumatoid arthritis patients who took cod-liver oil every day were able to cut their NSAID use by more than a third, Scottish scientists recently reported.
For osteoarthritis, try 2,000 to 4,000 mg daily; for rheumatoid arthritis and autoimmune diseases associated with joint pain (such as lupus), consider a much higher dose of upwards of 8,000 mg daily — but ask your doctor about such a large amount first, says Tanya Edwards, MD, medical director at the Cleveland Clinic's Center for Integrative Medicine.
People with osteoarthritis of the knee who took MSM had 25 percent less pain and 30 percent better physical function at the end of a 3-month trial at Southwest College of Naturopathic Medicine and Health Sciences.
None of the 46 patients who counted complained afterward, and only one of them could remember pain from the injection at all (among the 46 who didn't count, 19 said the injection hurt and 10 recalled what it felt like).
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An hour following their ingestion, NSAIDs begin damaging the intestines, causing alterations in a compound known as intestinal fatty acid binding protein (I-FABP).
In fact, a new report out of Boston University revealed that weekly yoga classes relieved pain, improved joint and muscle function, and reduced the need for pain medication. With pills being handed out like candy at hospitals and private clinics—not to mention the easy access of OTCs to combat minor aches and pains—it’s no surprise that many people don’t know exactly how to use NSAIDs properly, and thus overdose accidentally. Further, researchers at the Duke University Medical Center recently reported that even in healthy individuals, use of commonly available NSAIDs such as ibuprofen, diclofenac, and naproxen are linked to an increased risk of stroke.
Glutathione helps the liver detoxify acetaminophen, and in clinical trials it has shown the ability to kill breast cancer cells. While NSAIDs may be appropriate for those treating severe pain, like recovering from surgery or an injury, taking NAC alongside NSAIDs may be beneficial to maintaining the balance.
In fact, a recent study published in the Journal of Strength Conditioning and Research indicated that bromelain and papain restored muscle power shortly after exercise, quickly reestablishing that portion of muscle strength it had lost.
If for whatever reason you do take NSAIDs for targeted pain management, it’s important to be aware of how much and how often you are staggering your intake with other OTC products that contain acetaminophen. Furthermore, aromatherapy, bio-feedback, Epsom salt baths, deep tissue bodywork, hot and cold packs, massage therapy, and magnet therapy can help.
Patients at the New England Center for Headache decreased their migraine and cluster headache intensity after applying capsaicin cream inside their nostrils. But research on capsaicin and headaches remains limited — and don't expect stronger versions anytime soon: "Current formulations are better suited for more acute problems, like a sore muscle or an arthritis flare-up, than everyday pain and stiffness," Gregory says.
For the more readily accessible Zyflamend, take one capsule two or three times daily, but avoid it near bedtime — each pill contains 10 mg of caffeine (another version, Zyflamend PM, is reportedly less stimulating).
In a study of 70 volunteers published in Nutrition Journal, Aquamin users reduced arthritis pain by 20 percent in a month, and had less stiffness than patients taking a placebo. SAM-e can interact with other meds, especially MAO-inhibitor antidepressants, so it's vital to talk with your doctor before taking it (and avoid SAM-e entirely if you have bipolar disorder). People with neck and back pain have fared even better: After about 10 weeks, nearly two-thirds were able to stop taking NSAIDs altogether in a University of Pittsburgh study.
Recitation might work by distracting the brain from processing the sensation, says study author Tomoko Higashi, MD, of Yokohama City University Medical Center in Kanagawa, Japan. At this point, pain may be deemed “chronic” and it is no longer helpful as a sign of injury. Pain is an important signal that lets the body know something is wrong—but whether you’re male or female, athletic or not, using NSAIDs as a preventive measure is not the healthiest option.
Or, save money and try curcumin to start: Taking 500 mg four times daily, along with fish oil and a diet low in animal fat, can ease arthritis, says Jane Guiltinan, ND, immediate past president of the American Association of Naturopathic Physicians. Studies show that people who only sleep four hours per night will find that their pain thresholds drop significantly, says Dawn Marcus, MD. McIlwain, MD, notes that when the brain chemical serotonin is depleted from lack of sleep, sensitivity to pain increases and malaise (a general feeling of illness) develops.

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