Leadbetter W B
Department of Orthopedic Surgery, Georgetown University, Washington, DC, USA.
Clin Sports Med. 1995 Apr;14(2):353-410.
Strong statements regarding the efficacy of anti-inflammatory medication are based primarily on experience with rheumatic disease. Such experience, over 32 years, involving more than 400,000 injections in more than 12,000 patients, has led Hollander and associates to conclude that "no other form of treatment for arthritis has given such consistent local symptomatic relief in so many for so long with so few harmful effects." Such endorsement has not been clearly transferrable to sports medicine experience. Anti-inflammatory medications can unquestionably affect excessive inflammation. Whether this tissue effect is significant with regard to enhancing sports performance has been difficult to prove. To quote Oriole baseball pitcher Jim Palmer, "cortisone is a miracle drug ... for a week!" Perhaps this is because in rheumatologic disease, inflammation is the problem, whereas in sports injury, performance recovery depends on restoration of both the injured tissue and its kinetic environment. The tendency to place an inflammatory label (i.e., "itis") on sports-induced pain has promoted the value of anti-inflammatory treatment while risking a de-emphasis of the role of physical rehabilitation and even well-timed surgical repair. If pain and signs of inflammation are persistent, repeated efforts to turn off the body's alarm is not a substitute for finding the cause of the fire. Indeed, to remove the "fire alarm" of pain from the onset of an injury can clearly place the athlete in great jeopardy with respect to tissue overload and failure. Perhaps the greatest criticism that can be raised regarding anti-inflammatory treatment as a sole solution in sports injury is that it tends, in its worst application, to be too passive and dependent a modality and does not challenge the athlete's sense of responsibility to properly train, condition, and develop correct technique. Thus, anti-inflammatory therapy may succeed only if the patient has been instilled with the proper expectations and responsibilities. Increasing knowledge of the pathobiology of sports injury and the various treatments required for complete recovery has led the experienced clinician to rely far less upon anti-inflammatory medication as a long-term solution. Nevertheless, until more biologically selective drugs become available, the judicious application of anti-inflammatory therapy remains a useful, albeit adjunctive therapy for sports injury. The successful clinical rationale is best arrived at not by random selection but by cautious individualized prescription.
关于抗炎药物疗效的有力论断主要基于对风湿性疾病的经验。在32年的时间里，超过12000名患者接受了40多万次注射，霍兰德及其同事据此得出结论：“对于关节炎，没有其他治疗方式能在如此多的患者身上长期持续地缓解局部症状，且副作用如此之少。” 但这种认可并不能直接套用到运动医学领域。抗炎药物无疑可以抑制过度的炎症反应。然而，这种对组织的作用是否能显著提升运动表现，却很难得到证实。引用巴尔的摩金莺队的棒球投手吉姆·帕尔默的话来说：“可的松是一种神奇的药物…… 只管用一周！” 或许原因在于，在风湿性疾病中，炎症是问题所在；而在运动损伤中，运动表现的恢复依赖于受损组织及其运动环境的恢复。给运动引发的疼痛贴上炎症标签（即 “炎”）的倾向，提升了抗炎治疗的价值，但同时也可能导致人们忽视物理康复甚至适时手术修复的作用。如果疼痛和炎症迹象持续存在，不断尝试消除身体的警报并不能替代找到问题根源。实际上，从受伤一开始就消除疼痛的 “警报”，显然会让运动员面临组织过载和功能衰竭的巨大风险。对于将抗炎治疗作为运动损伤唯一解决方案，可能提出的最大批评是，在最糟糕的应用中，它往往过于被动和依赖，无法激发运动员正确训练、调整状态和培养正确技术的责任感。因此，只有当患者树立了正确的期望并承担起相应责任时，抗炎治疗才可能取得成功。随着对运动损伤病理生物学以及完全康复所需各种治疗方法的了解不断增加，经验丰富的临床医生越来越少将抗炎药物作为长期解决方案。尽管如此，在有更多生物选择性药物出现之前，明智地应用抗炎治疗仍然是一种有用的辅助治疗方法，尽管只是辅助性手段。成功的临床依据最好不是通过随机选择，而是通过谨慎的个体化处方来确定。
