New York, NY—June 14, 2004
Preliminary research in a study of small laboratory animals suggests that widely prescribed pain medications may possibly 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 [i] and the use of pain medications is standard post-operative procedure.
The researchers will present their data on June 25 at the meeting of the American Orthopaedic Society for Sports Medicine in Quebec City, at which time they will also receive the Society's "Excellence in Research Award" for their efforts.
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, M.D., 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. [ii]
Co-authors from the Hospital for Special Surgery - Cornell University Medical Center team include David Cohen, MD; Sumito Kawamura, MD and John Ehtshami, MD.
i. National Center for Health Statistics, National Ambulatory Medical Care Survey, 2001.
ii. Spector, Reynold. "NSAIDs and Cox-2 Inhibitors: Selective vs Standard Use." Panel discussion, Medical Crossfire, 2001.
About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.