This article is a transcribed edited summary of a video Bob and Brad recorded in November of 2020. For the original video go to https://www.youtube.com/watch?v=SVDsfgI7KAw&t=76s.
Brad: Hi folks, Brad Heineck, Physical Therapist.
Chris: Hey, I'm Chris the Pharmacist.
Brad: And today topic: Are you injured? Heal faster while you sleep. Simple inflammation management is the key. This is science-based, we have Chris the Pharmacist here, he's going to fill us in on all the science so we can understand it and go through the whole three pronged approach to get this goal completed. All right, so Chris, heal faster while you sleep. That's a pretty cool thing, but is it true? And if it is true, can you explain what the key is?
Chris: Yeah, well, it's kind of interesting. We do seem to heal faster when we sleep. And there was a pretty cool study that came out this last January. The study specifically is called, "Chronotherapy of NSAIDs May Enhance Post-Operative Recovery."
Brad: I don't know what the heck you're talking about!
Chris: All right, all right.
Brad: Can you shorten that up to something that I can understand?
Chris: Basically what it's saying is timing is everything. And so the key is, when you take an anti-inflammatory drug, like Ibuprofen.
Brad: Okay, across the counter?
Chris: We'll use that as our example. And that's what the study used, was Ibuprofen. Just plain old Ibuprofen like you get, Advil, Motrin, Ibuprofen at any local pharmacy or online source.
Brad: So you look on the box, it says, "Main ingredient: Ibuprofen 200mg"?
Chris: 200mg, yup, you betcha. So, always check with your doctor, make sure it's right for you. Those of us that have kidney problems, heart problems, we have to be really careful with it. But for the purposes of this study, and making sure that we're going to get the best possible healing, this was some interesting stuff. Basically, the subjects were divided into an active group and resting group. They all had an injury that they had to study. Basically what happened was, we know a lot of things about anti-inflammatories. Since the 70's we have known that anti-inflammatories, like Ibuprofen, actually can delay healing. Particularly from a post-operative standpoint.
Brad: Actually delay, slow healing down?
Chris: Slow healing down.
Brad: We know that, but everyone takes it?
Chris: Everyone takes it. So it's kind of a conundrum. We've gotten a lot more advanced in our understanding of how our bodies work. What the authors of this particular study looked at very clearly, is they noticed we have genes that govern our circadian rhythm. That cycle that tells us when to sleep, and when to get up, and what we do throughout our day.
Brad: Yeah, that is kind of been, not a buzzword, but something people are more familiar with.
Chris: Yeah, so they found that we have these clock genes that kind of govern that, and it seems to work hand in hand with the inflammatory process. So it was really interesting. Like I said, we know that NSAIDs may delay healing, but at the same time we know that they help with pain relief, they help reduce inflammation, so we feel better. So it creates kind of a conundrum.
Brad: So the inflammation, you're saying the swelling is good? It actually helps us heal?
Chris: Swelling is actually a good thing. It's our body's natural way of getting all those little chemotactic factors, these healing factors that come in to try and help us to kind of calm things down, and allow new tissue growth, whether it's a broken bone, a torn ligament, a strained muscle, tears. So our body has a unique way of understanding what injury it is, and how to heal it.
Brad: So it inflames, it swells up, and all of the fluid, the inflammation, is actually full of good things to help it heal faster?
Chris: Correct.
Brad: So we take Ibuprofen to do what?
Chris: Reduce the inflammation.
Brad: See, I always kind of thought that, you do it, there's that good stuff in there, but it gets to be too much, and it swells up, and the actual pressure creates pain, so the Ibuprofen actually just releases it enough so it doesn't hurt. Like it takes the air out of the balloon, a little.
Chris: It takes the edge off. And for most of us, for comfort, humane use, that's kind of what we use it for. But Ibuprofen not only is an anti-inflammatory, it's also analgesic, so it helps with pain relief. So we'll kind of touch on that, to a degree, with the example in the study, as well. What they did with the subjects is they kind of grouped them up. Because we know that our cycles, again the circadian rhythm, so we're trying to figure out: When's the best time to take Ibuprofen, so we can get the best possible healing? We don't want to inhibit it. So what they've kind of postulated is that when we're asleep at night, that's when our best tissue recovery occurs.
Brad: So it's healing the best while you sleep. And I think that's pretty easy to accept.
Chris: Yup, exactly. But during the day, that's when your pain is highest, because our bodies are active. So let's say you sprained your ankle. You're going to kind of guard that joint, or you're going to limp a little bit, or you're going to keep pressure off of it.
Brad: Crutches.
Chris: You're not going to necessarily have your full range of motion. So with respect to that, they found that these painful mediators go up and same with some of the tissue tear-down factors also go up during the day, in our active phase. So what they postulated was, we're going to give Ibuprofen to this group of subjects in their active period, and we're going to give Ibuprofen to the other group of subjects in their resting period. And what they found was pretty interesting. So when they compared them, across the board they found, exclusively, that the active group that was taking Ibuprofen healed much better. Their bone volume was better, because it was on broken bones, was what the study was. And so the bone volume was better, they had better union, where the bones come together. They had less guarding during the day with pain relief, so meaning that they had a more, I guess better gait.
Brad: Oh, quality of walk. Right.
Chris: So when they noticed those, and then they compared it to the resting group. The subjects slept really well, and they were much more comfortable, and they also see that rest is healing. But, when they actually examined the bones at the end point of the study, they showed less healing. Delayed and even very diminished healing.
Brad: So the bottom line is, if you take the Ibuprofen before you go to bed, with the idea "I will sleep better, I'm going to have less pain, less pain when I get up." That may be true, but the healing is actually slowed down as a result. So you want to take the Ibuprofen two hours before you go to bed, six hours?
Chris: They didn't really identify that. Basically what they did, they equated to a 500mg dose of Ibuprofen for the subject matter. So from that standpoint, they didn't actually, like how people take it, it's two tablets every four to six hours apart. So they didn't really examine that. They gave it as a dose, equivalent to the subjects. What we know is that if you take Ibuprofen through the day, you'll take it a couple times, two-three times during the day. We probably wouldn't want you to, based on this study, it almost seems like you probably wouldn't want to take it past 6:00 at night. So that if you're going to bed around 10:00. But they also showed, with the gene expression, that our pain factors actually are, probably from let's say you were a typical person gets up at 6:00 in the morning. And kind of the evening they kind of rest, relax, wind down. By bed time, the pain's not so bad, simply because they've begun to relax. And then sleep is when all these other factors kind of come into play. There's other inflammatory factors that come in. The fluids that we're having. What they found is that if you cut that supply off using the anti-inflammatory, you're prolonging the healing stage. So it's going to take longer to get better. And maybe inhibit some of the healing.
Brad: Sure. So, the bottom line is, if you're going to do a three...
Chris: Three times a day.
Brad: Three times a day, maybe in the morning when you get up, between 6:00 and 8:00. Lunchtime, dinnertime, but don't take it before you go to bed.
Chris: Yeah, it seems like if you need something for pain relief, you might want to go with Acetaminophen or something like that. But not an anti-inflammatory.
Brad: Sure, okay. So if you're going to take the ibuprofen, take it those times, take it with some food, at least some milk. Is that correct?
Chris: Definitely want to take it with some food. But, you know, the big thing too, to take away on this, is this is a theoretical study, and it's not done on people. It was done on animals. So we want to be really careful with that. Talk with your doctor to make sure of it. But I mean, the logic and science is really sound. I think it might unlock a lot of possibilities. Because the problem is, with pain relief, rest is healing, and if we got pain we don't rest well. And if we're not resting well, we're not healing well. So we've got to come up with a way that's going to do a better job. And we know that anti-inflammatories are a good pain killer. We know that opioids are a good pain killer. Probably the combination is something that, at least post-surgically, that most doctors will always do. But they don't want to put people on opioids too long, because obviously there's addiction and other side effects that occur. But the same thing with NSAIDs. If we take NSAIDs all the time, we run the risk with our kidneys having some trouble with that. People that have bad hearts...
Brad: NSAIDs?
Chris: Non-Steroidals, like Ibuprofen. So Naproxen, and then there's several prescriptions as well. We want to make sure that our doctors are aware, the doctors are going to be acutely aware, but talk it over with your doctor if you've got kind of a game plan. Like, "Hey I heard this study, it said that maybe it's better to take this during the day time, and lay off the anti-inflammatories at night." Just see if it's right for you. You know, we don't want to steer you in the wrong direction. But the study seems pretty overwhelmingly positive that daytime use does a better job for you. Better healing while you sleep.
Brad: Then we did say three-pronged, so you go onto the next phase and this is more where a therapist comes in. And its basic information. Elevate. If you got a swollen ankle, elevate it. Don't leave it hang down where you're sitting, get it up in a chair in front of you. Or on a couch, above the level of your heart. Get gravity working with it. You can wrap it with an ACE wrap. Not too tight! That's the biggest mistake people make, is they wrap too tight. You should be able to easily slip two to three fingers underneath the ACE wrap and easily pull them out. It should not be too tight, otherwise it acts like a tourniquet, things do not flow. And then cold packs. I'm a big fan of cold packs. Not for everyone, they only use them if they feel good and you get good results while you use them and afterwards, the next two to three hours. But there are some studies coming out that are showing cold packs may not be the way to go. But, I tell you what, I'm going to have to really examine those, because I've had really good luck, personally, as well as with patients over the last 20 years. So I think you're pretty safe using a cold pack. Those are the three points. Ibuprofen, don't take it right before bed. Take the proper amounts. Compression, elevate, and cold packs. So, wow, I'd say Chris you gave a full and detailed explanation of the recent studies, and I don't know what else to say. But one thing's for sure, I don't think it's going to help with a broken heart.
Chris: Nope, we can't figure out how to fix that, yet.
Brad: And we're working on that. Very good. Take care until the next time.
Chris: Thanks guys.
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