Pain pill during rotator cuff surgery may delay healing

Preliminary research in a study of small laboratory animals suggests that widely prescribed pain medications may actually 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 presented their data on June 25, 2004, at the meeting of the American Orthopaedic Society for Sports Medicine in Quebec City.

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, MD, 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 .

SOURCE: Hospital for Special Surgery press advisory, June 24, 2004.