When a quick painkiller fix leads to long-term woes

Ever had an annoying pain preventing you from working out at your full potential for weeks or months on end? I guess the answer is yes for most athletes. Injury in sport is as inevitable as tax and death. And when it comes to working out at the gym, opportunities abund to contract one of these pesky injuries that do not sideline you altogether but hamstring you enough that your 1-max rep is durably affected.

THE MAGICAL CORTISONE FIX
The vast majority of these injuries are muscular or affect tendons. In my own experience what has long been called "tendinitis" is the most frustrating type of injury as it often resists all conventional treatments such as the commonsensical "Rest, Ice, Compression, Elevation" routine. To defeat such a stubborn enemy, one may be tempted to resort to an "industrial strength" treatment, which more often than not means using cortisone in one of its many forms.
This is what I did about 15 years ago as the pain in my right wrist would not subside after 6 months and 2 voluntary 2-week pauses. I eventually consulted a couple of sport physicians, the second of whom eventually offered too quick and painless a fix for me to resist: "we can try a cortisone shot or two; that will take care of the pain" And that it did big time, providing an instantaneous relief so magical that the experience temporarily changed my perception of the drug industry as a whole: yes there really were miracle drugs after all !

Subsequent brushes with the medical establishment quickly brought me back to earth. Still up until last year I had considered cortisone as one of the truly great inventions of the 20th century in the medical field. And it probably still is for a range of serious conditions, but definitely not for sport injuries such as tendinitis. To learn more about why cortisone is not a good indication for tendinopathies after all, I recommend that you read this excellent article in the New York Times.

A PAINKILLER MYTH SHATTERED
After feeling pain in my right wrist for the very first time in 15 years, I consulted with a renown hand surgeon last December. And my cortisone myth was shuttered. According to him, the cortisone shot in my wrist, by durably masking the pain, had made it possible for me to overuse the affected joint in the ensuing months and years, preventing it from ever healing completely. The end result: irreversible osteoarthritis. "Your wrist looks like that of a 65-year old, how old are you again?" he asked me. About 20 years younger. In other words, the cartilage in my right wrist was prematurely worn out probably as a result of this single cortisone shot.

PAIN IS OFTEN USEFUL
The moral of the story is this: pain does not exist for nothing. In most cases it is a very useful function of the human machine intended to warn you that you should not touch, exercise or expose a particularly part of your body before it has healed. Ignoring this warning is at your own risks. Thus taking pain killers, of which cortisone is a supercharged version may have adverse long-term consequences by making it possible for you to keep on using something in your body that should absolutely be kept at rest. My sore wrist example is just one of many sport injuries to which this principle apply.

THE MOST COMMON BACK PAIN MISCONCEPTION
I must mention here lower back pain because it may constitute both the most common and serious example of this principle. Whenever your back hurts (because of a lumbago for example) you should heed the message your body is sending you. IN THE VAST MAJORITY OF CASES YOU SHOULD NOT TAKE ANY PAIN KILLERS OR ANTI INFLAMMATORY MEDICATION. If you do (and a lot of ill-trained physicians will encourage you to use them anyway) you will lose the precious information, namely the pain, that will tell you exactly what movement to avoid and what you can still do safely, with potentially disastrous long-term consequences because of continued joint overuse.


PAINKILLERS ARE VERY USEFUL, BUT PROBABLY NOT FOR WHAT YOU HAVE
Let there be no misunderstanding though: I am in no way anti-medication in general or anti pain-killer in particular. I consider morphine for example as one of the most useful drug ever invented particularly for people with chronic pain associated with serious diseases like terminal cancer. By contrast, in most cases a lumbago or a sore wrist are no justification for using painkillers. If you incur a routine injury while working out, consult your chiropractor or physical therapist first. Do not pop a pill or get a shot or you may pay dearly for a quick fix later on in your life.