Ibuprofen for Backpacking: Why It’s Probably A Bad Idea
Pain. It’s one of the few inevitabilities associated with long distance backpacking. Even those in the best of condition will face pain at some point during their journey- early and often is usually the safest bet. When you wake up in the middle of night and your joints feel as if they’ve been filled cement and muscles lined with barbed wire, the prospect of pushing double digit miles up and down mountains first thing in the morning becomes a thought too much to bear.
Backpackers most commonly turn to Ibuprofen (otherwise known as Advil, Motrin, and others) to ease this physical misery. It’s such common practice, in fact, that this over the counter anti-inflammatory has been dubbed “Vitamin I” in the world of backpacking and endurance sports at large.
Is it safe?
For years, conventional wisdom has said that the continued use of Ibuprofen, by and large, poses very little risk. For the purpose of treating chronic pain, according to WebMD…
“Anti-inflammatory drugs have a long history of success. Many people are able to manage their chronic pain quite well using NSAIDs as part of their management plan. For most, side effects, if any, are minor.”
Anecdotally speaking, during my AT thru-hike in 2011, I witnessed people popping Advil like candy- to both treat and prevent pain. I was one of these people. Not only did I hold the belief that Advil could do no wrong, but being surrounded by others who did the same made the decision a no-brainer.
Risks of long term use
More recently, however, long term use of Ibuprofen has been shown to be less safe than once imagined. Most notably, gastrointestinal bleeding and cardiovascular risks are cited as two of the more common and severe side effects. Renal failure, as Dr. William Cimikoski, a Medical Toxicologist and founder of the Utah Stem Cells at Intermountain Health and Wellness, highlights as another risk posed by extended use of ibuprofen.
“Very large single ingestions may cause some mild renal failure that is easily and quickly reversible when you stop taking any more ibuprofen and simply rehydrate. But more serious nonreversible renal failure that occurs with chronic therapeutic use is more significant and not easily reversible,” says Dr. Cimikoski.
Added risks for endurance athletes
And as fate would have it, not only does long term use of ibuprofen increase one’s likelihood of GI bleeding / ulcers, but combining it with endurance sports may raise this risk even more. One study looking at the combination of ibuprofen and brisk stationary bicycling found that the two stacked together resulted in increased intestinal leaking compared to either activity by itself. As Gretchen Reynolds of the NY Times reports:
“It may be that if someone uses ibuprofen before every exercise session for a year or more, she said, ‘intestinal integrity might be compromised.’ In that case, small amounts of bacteria and digestive enzymes could leak regularly into the bloodstream.” She continues, “in a famous study from a few years ago, researchers found that runners at the Western States 100-Mile Endurance Run who were regular ibuprofen users had small amounts of colonic bacteria in their bloodstream.”
The post goes onto suggest that long term use of anti-inflammatories might actually increase bodily inflammation as a result of leaked bacteria into the bloodstream.
From a backpacker’s standpoint, the line between treating and preventing pain is indistinguishable, as the activity, and therefore pain, lasts for weeks or even months.
When is use considered “extended”?
Short term use of NSAID’s is still generally considered safe. So the question is raised, what qualifies long-term, high risk use?
“That’s a question that is not entirely known,” says Dr. Cimikoski. “Their is no absolute number. The amount of time someone could tolerate taking therapeutic doses of ibuprofen without getting significant adverse effects such as GI bleeding and renal failure is going to be different for everyone. Some people will get it after a couple of months and some will never get it after taking it regularly for years.”
He continues, “it’s safe to say that a generally good recommendation to follow is to take ibuprofen only as needed, and not around the clock for longer than a few weeks or at most a couple of months. I would recommend not taking it more than 2-3 weeks at a time and then giving yourself a break, if at all possible, for a couple of weeks. This type of practice would usually be safe.”
This likely presents good news for many section hikers and bad news for AT, PCT, and CDT thru-hikers, whose time on trail is measured in months, not weeks.
For most, the prospect of dealing with chronic pain is likely much worse than an elevated risk of intestinal bleeding or kidney failure. One is a certainty and an immediate, nagging issue, the other is a roll of the dice.
But are there alternatives to Advil that won’t turn your stomach into a war zone?
WebMD recommends fish oil, turmeric, green tea, ginger, and rosemary, amongst others, as natural, safer alternatives to over the counter NSAID’s. The article states that any of the supplements used in isolation may not work as effectively as Ibuprofen, but in combination, the painkilling effects are enhanced.
Additionally, much of a backpacker’s pain is caused by their own ambition, which is to say, pushing oneself too far on a daily basis. If pain becomes too much to bear, instead of treating the symptoms, it’d be much more impactful to address the root problem. Pain is likely caused by too many miles, too heavy a pack, or a combination of the two. Check out our recommend thru-hiker’s gear list to get an idea of what a standard pack should look like.
Don’t let this article, or any other, solely determine your pain management plan while on the trail. If popping an Advil here and there will make the difference between completing your thru-hike (or otherwise) and throwing in the towel- maybe it’s worth taking a calculated risk. I’m not a doctor nor do I pretend to be one on the Internet.
Instead, I hope you at least consider the potential long term consequences associated with repeated use of “Vitamin I”. As it turns out, the body is wise. Pain is feedback and using drugs to silence this information isn’t without repercussion. Whether you listen to this information, decide to override it, or shut it down is up to you. Just be aware that when it comes to taking drugs, there is no biological free lunch.
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I think this is a great reminder that Ibuprofen is a drug. It’s become ubiquitous and definitely has its uses, but we all probably need to ween ourselves from it. I took way more than was necessary on the AT … part of it being the “I’m invincible” thinking of youth. That four here was somehow better than two – all without any sort of medical training or thought.
The “Vitamin I” term is funny, but it adds to this greater mentality, I think, that Ibuprofen has no ill effects, like it’s a superhero pill.
This is overall an excellent article. I am not a thru-hiker or even a section-hiker; I am a toxicologist married to a thru-hiker, however, and we have had several discussions about topics such as these.
I do have one very minor issue with your advice at the end, however. I am not convinced that natural products are truly a better option here. For one thing, many of those substances are poorly studied in comparison to ibuprofen. Just because there is not a vast body of scientific literature detailing the dangers of these substances does not mean they are inherently less dangerous. Secondly, several of the particular alternative substances you listed, such as turmeric and green tea, have extremely low bioavailability. In other words, unless directly applied to the site of action (e.g., administered in some injectable form), they are mostly ineffective.
As Carl Sagan says, “absence of evidence is not evidence of absence.” I don’t disagree with your point, but on the flip side, just because there have been fewer studies conducted around these natural alternatives, doesn’t mean that they aren’t viable alternatives. The cited reference for that point came from the medical director of the Center for Integrative Medicine at the Cleveland Clinic who says that she has “had patients with arthritis who start using turmeric and are able to go off their NSAIDs entirely.” She also concedes that tumeric can pose similar risks to NSAIDs, but the side effects are less severe.
In either case, you are a toxicologist and I am a guy who writes things on the www. When it comes to medical arguments, you win. But when it comes to treating minor symptoms in my own body (i.e. not potentially life threatening ailments), I’m much more willing to roll the dice with herbs and food, something that has been used for millennia, as opposed to something created in a laboratory a few decades ago.
Not trying to “win” here; just trying to add to the discussion. It’s very rare that I see rational discussions of medication, such as your article here, on non-science blogs. So when I do see such a thing, I can’t help but want to jump in!
Admittedly, that hit a pressure point as western medicine had nothing for me in improving my health after contracting West Nile virus. Only after radically altering my diet, supplemental practice, and lifestyle did the symptoms subside. I’ve been a staunch advocate of alternate-medicine since. In other words, perhaps an over-reaction on my behalf 🙂
Thank you for adding to the conversation. Getting the $0.02 of someone with your credentials is appreciated and adds value to the discussion.
I think it’s important to remember that chemicals are chemicals – whether natural in origin or synthetic. There are plenty of “natural” substances that are bad for us. I think the key here is moderation whether it’s turmeric and green tea or ibuprofen. Zach, your article stressed the concept of not overdoing the treatment of pain, which is key.
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Despite being an endurance athlete, I have only taken ibuprofen a handful of times. This isn’t because of the negative side effects that you outlined in this article, even though they are all valid points.
I was a national level swimmer for close to a decade, and my coach was fervently against ibuprofen. While it does indeed bring down the inflammation, which aides in recovery, he would become livid if we ever took it during or before a practice or competition. His reasoning behind this is while it helps to manage pain, it does so by desensitizing you to the feeling of it. Pain is an important signal from your body, and by suppressing and ignoring pain it is much easier to hurt yourself long term.
I know many people that have “pushed through” pain and end up worsening their injuries and increasing their recovery time. I’m curious as to what others think about this, and if it’s seen as a viable argument against medicinal pain management (other than the harmful side effects of many drugs).
Yes extremely valid point that the majority of people do not see or forget, intervention drugs are a last resort in my mind, best to hike in a manner sustainable for your body in the first place
Magnesium! Seriously excellent for muscle cramping and relaxation.
Bonus: Magnesium Citrate is a stool softener.
Great info, thanks!
I hear yoga and massage are also great alternatives to Vitamin I … Has anyone catalogued a list of studios in trail towns?
I have taken Ibuprofen for more than 10 years daily for arthritis and joint pain migraines and have never had a problem i am not having any issues while taking on a daily basis
When on the trail I take a similar NSAID, Aleve, in the morning and that’s it. If I’m experiencing more pain than normal later in the day I’ll take some ibuprofen, but I usually only take a single one just before bed to keep my feet from swelling up.
I read once that anti-inflammatories can actually prevent muscle growth and recovery because those two things are a reaction to inflammation? Wonder how true that is.