Understanding NSAIDs in Clinical Physiotherapy Practice: A Barefoot Perspective

Our Clinical Insights

This is general information, we tell clients to ask for individual advice from their pharmacist or GP: 

You will be aware of the standard 4 over the counter NSAIDS: Ibuprofen, Naproxen, Diclofenac or Aspirin and these are the medications people tend to know about and use. We find if a medication has worked well for someone in the past it is often a good first port of call. Empowering people to know what works best for them we find to be key.  

Clients often have a good understanding that they shouldn’t take more than one NSAID but sometimes can get confused about Aspirin and Paracetamol. Aspirin is one of the NSAIDs so cannot be combined with others. Paracetamol is not and in fact for some people is a good combination to take with their NSAID and may reduce their amount of NSAID required.  

Another common misconception: People thinking Naproxen is just for period pain! It can be used for musculoskeletal pain and inflammation and we see it being clinically effective especially with acute low back pain.  

For all NSAIDS the key we find is for the client to have the medication in a good therapeutic dosing window (taken consistently, usually 3 times a day, for 5-14 days). This is often the most misunderstood aspect of NSAIDs. For acute inflammation the timing of the inflammatory cascade means that a true anti-inflammatory effect takes 3 days to be felt. So make sure medication is taken regularly for at least that long.  

Clients should see good results of the medication within 5 days and if not they may need to change medication. Sometimes it is hard to know if the improvements are from the medication or the physiotherapy treatment (often it is both) – but if they are not making the improvements expected they may need to change (for example from Ibuprofen to Diclofenac). About 60% of people will respond to any NSAID; those who do not respond to one may respond to another. 

With good physiotherapy management often clients will be able to wean off the NSAIDs at 2 weeks or earlier. In our experience our client demographic tend to wean themselves earlier rather than later (this may be skewed data due to our client population). 

It is clinically important that decreasing their medication and holding  their objective testing ranges is a big win – and we ask them to communicate regularly with where their medication is at.  

For chronic inflammation like Osteoarthritis it can take up to 2-3 weeks to see full effects of the medication – this is often managed by a GP medication referral.  

Of note: GP prescribed anti-inflammatories won’t necessarily have a higher effect but they will have access to medications that are Selective to Cox 2 (Celecoxib and Meloxicam) as well as ones that have dosing frequencies that decrease tablet burden (eg 1-2 tablets a day instead of 6). There is often a misconception that GPs have access to ‘the good anti-inflammatories’. Moreso they can provide access to different ones for people that need more tailored medications.