NSAIDs and Stem Cells: Naprosyn Messes Up Cartilage

By Chris Centeno, MD /

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nsaids and stem cells
I highlighted a study recently that suggested that taking NSAID drugs long-term could cause more arthritis. However, the question is how that could happen. Now another recent study sheds light on a possible mechanism for how that could work—NSAIDs cause abnormal cartilage to be manufactured because of the interaction of NSAIDs and Stem Cells.

NSAIDs in the Water Supply

It’s amazing that every single guideline for treating an acute injury involves taking NSAID drugs. These are anti-inflammatory medications that include drugs like Motrin. Aleve, ibuprofen, Advil, Naprosyn, Celebrex, celecoxib, Mobic, and meloxicam (just to name a few). Doctors and the public seem to be under the bizarre illusion that these drugs are safe, when in fact they’re the most dangerous medications you can buy over the counter. Not only can they cause nasty stomach ulcers, but, more importantly, all NSAIDs increase your risk of having a fatal stroke or sudden-death heart attack. The lowest risk is Naprosyn, which more than doubles your risk of a stroke or heart attack, and the worst is Voltaren, which almost quintuples it!

We’ve told patients for years to get off NSAID drugs prior to a stem cell procedure, which can sometimes be quite difficult as many middle-aged and elderly patients take this stuff just to function normally. They begin to get aches and pains in middle age, and rather than managing them with diet, exercise, and natural supplements, like high-dose fish oil, curcumin, or glucosamine/chondroitin, they begin to pop Motrin pills like they’re scarfing M&M’s. The problem is the relationship between NSAIDs and Stem Cells as these little pills will mess up your stem cells. Let’s look at how that works…

How Cartilage Is Made

New cartilage is made in your joints all the time. When you go for a run or even a walk, many cartilage cells and little bits of the matrix they produce are lost. This needs to be replaced, and that happens by local stem cells differentiating into cartilage cells to replace the dead ones. The new cartilage cells then lay down the stuff where they live, known as extracellular matrix, or ECM. In a joint, the cartilage cells plus the ECM are what we call “cartilage.”

The composition of the ECM is critical so it can resist force. In order for it to be strong enough, the right type of collagen has to be produced. Collagen is the stuff that makes up our skin, hair, bones, and many other tissues. It comes in many different flavors or types. Each organ or body part can be engineered to have certain properties, like more or less stretch or more or less firmness, just by altering the composition of the different collagen types. One of the things we know about bad cartilage (like the type found in arthritis) is that it has more collagen X (ten). This makes it too soft and unable to withstand normal forces.

The Dangerous Interaction Between NSAIDs and Stem Cells

The recent study looked at Naprosyn, also known as Aleve, as well as other NSAID drugs. The authors had found in a prior study that Naprosyn (but not other NSAID drugs) altered gene expression in stem cells for type-10 collagen (caused the cellular machinery that makes this protein to be stuck in overdrive). This study looked at stem cells from normal healthy patients and from patients with arthritis. The cells were then exposed to Naprosyn or not and then given clues to become cartilage cells. The cells exposed to Naprosyn made too much collagen X. Interestingly, this was happening because one of the inflammatory pathways that Naprosyn and other NSAIDs doesn’t block was also placed into overdrive. Also very interesting is that there are supplements, like high-dose fish oil and curcumin, that we know block this other inflammatory pathway (lipoxygenase).

So is Naprosyn the only bad actor? Not in the least. Here’s another study showing that Voltaren causes stem cells to turn into fatty pieces rather than turning into normal tendon cells. Other studies have shown that NSAIDs also mess with new bone formation and healing (although pharma has been working overtime to produce research reviews to block this one as this messes with orthopedic surgeons prescribing NSAIDs for postop patients).

The upshot? Normal inflammation is how we heal. So just from a 30,000-foot view, blocking it in a patient trying to heal or undergoing a treatment like stem cell therapy, where healing is the primary aim, just seems ill-advised. Now we have multiple studies that show that the interaction between NSAIDs and stem cells will mess with stem cells at multiple levels and through multiple mechanisms. So if you’re seeing a doctor who wants to perform a stem cell treatment, and he or she doesn’t provide advice to get off the NSAID sauce, find a new doctor!

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33 thoughts on “NSAIDs and Stem Cells: Naprosyn Messes Up Cartilage

  1. Shahab Shamsi

    This is an interesting article and should open our eyes. The issue is what alternative we have for pain managment and pain relief in arthritis. Curcumin and Fish oil might be a good alterative but what high doses of fish oil one would need to have the same effect as 800 mg of ibuprofen does in decreasing pain and inflammation. When we get stem cells obviously there is a time of healing, so what pain medications are safe to use and will work effectively to manage healing (again after stem cell therapy).
    Dr. Cenntenno, can you please elaborate and provide solutions as well.
    Thank You

    1. Regenexx Team Post author

      Shahab,
      We put a year’s worth of lab research into determining what supplements in what ratio supported stem cells and chondrogenesis best and created the Advanced Stem Cell Support Formula, which is what we recommend to our patients. (ingredients shown) http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ Many people have found good alternatives in Curcumin and Fish Oil, which you’ll find there as well. http://www.regenexx.com/curcumin-for-knee-arthritis/ http://www.regenexx.com/blog/nsaid-addict-can/ Unfortunately, treating arthritis with NSAIDs is alot like treating psorosis of the liver with vodka!

    2. Connie Howard

      i have arthritis all through my body. i would like to try curcumin, where can i get this and how much of fish oil=800mg of ibuprofen

      1. Regenexx Team Post author

        Shahab,

        Dr. Centeno explains what type and how much fish oil to take here: http://www.regenexx.com/how-much-fish-oil-should-you-take-for-your-arthritis-and-stem-cells/ It’s important to take good quality curcumin with bioperrine added for greater bio-availability. We’ve done the legwork and have one that we’ve researched and do quality control on, on the website here: http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ (fish oil as well) but if you will be purchasing it in a store, look for those ingredients in a good quality healthfood store. Please see: http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ and this is what types of things to avoid: http://www.regenexx.com/stem-cell-supplements/

  2. Dave zinn

    That’s really good to know as I just had stem cells injected in my shoulder and hip. This the third time for stem cells for me and each time I was told not to take NSAIDs each time. So far I have had good success with this therapy. Thanks to Dr Schultz for all your work. Dr Stiene has done great work for me again.

    1. Regenexx Team Post author

      Dave,
      Great to hear! I will pass that along to Dr. Schultz and Dr. Stiene…

  3. Susan Maass

    Got off of Aleve a few months before extraction of SC’s in Cayman and never to use again almost two years ago. Do these NSAIDs do permanent damage or can our bodies repair the harm they’ve done? My SC’s were not as “healthy” as they could have been and I blamed the Aleve.

    1. Regenexx Team Post author

      Susan,
      That’s an important question. Dr. Centeno jumped in and answered above.

  4. William

    I quit using Celebrex during the bone marrow stem cells injections , basically you’re saying not to use the Celebrex afterwards ?

    1. Regenexx Team Post author

      William,
      This is something to discuss with the Doctor who did your procedure, as each case is unique and they are the expert on your case. However in general, to maximize the potential of the procedure and to make sure those stem cells get to produce good cartilage, NSAIDs should be avoided. The Advanced Stem Cell Support formula was based on a year’s worth of research to find the supplements and in what ratios actually support stem cells and chondrogenesis. http://www.regenexx.com/regenexx-advanced-stem-cell-support-formula/ Long term, many people have found fish oil and curcumin have controlled pain and inflammation well.

      1. William Wolfmeyer

        Thank you for being so prompt and I am using the fish oil, curcumin ,Black seeds oil and what is the best glucosamine & chondroitin. Bayer aspirin ok?

        Best regards
        Bill

        1. Regenexx Team Post author

          Bill,

          We know the quality of the Glucosamine and Chondroitin in The Advanced Stem Cell Support Formula which also has, curcumin, bioperrine, bittermelon and resveratrol, which has been found to protect cartilage:http://www.regenexx.com/blog/supplement-for-cartilage-protection/ But any quality brand from a trusted Health Food store will work, providing it does not use shark cartilage as it’s source. For Glucosamine, take 500mg twice a day of a brand that has both the sulfate and HCL forms of this natural compound. For Chondroitin, it’s 1,200 mg a day, usually taken 600mg twice. http://www.regenexx.com/blog/shark-cartilage-side-effects/ Aspirin, though it doesn’t have the cardiac risk, is technically an NSAID. I will inquire if creates the same problem for cartilage…

  5. Chris Centeno Post author

    Susan, I would assume that the cartilage, which has constant turn-over, would recover at some point as normal cells begin to produce normal collagen matrix.

  6. Tommy Teeburn

    How about using CBD drops for the anti-inflammatory effect after stem cell therpy?

    1. Regenexx Team Post author

      Tommy,

      Cannaboids can encourage stem cells to produce bone rather than cartilage which is not what we want, so they should be avoided for 6-12 weeks after a stem cell procedure.

  7. Justin Brown

    I’m also Interested if CBD oil will help with pain instead of NSAIDS.

    1. Regenexx Team Post author

      Justin,
      CBD oil can be used for pain, rather than NSAIDS.

  8. Lee

    What dosage of CBD oil is recommended to relieve knee inflammation and pain after the stem cell procedure?

    1. Regenexx Team Post author

      Lee,
      This is over the counter here so I have no dosage recommendation.

  9. Cheryl

    How long after stopping NSAID does cartilage heal?

    1. Regenexx Team Post author

      Cheryl,

      The issue with NSAIDs is that it causes the production of defective cartilage.

  10. Debbie

    I would like to stop using diclofenac, can you recommend an over the ctn fish oil and Curcumin that would be equal to the relief I am getting from the diclofenac

    1. Regenexx Team Post author

      Debbie,

      This was written to assist in that process: https://regenexx.com/blog/nsaid-addict-can/

  11. Deb

    Above posts .. one says do not use CBD and the other says you Can.>??

    1. Chris Centeno Post author

      We only have a prohibition on the use of marijuana and specifically THC, not CBD oil without THC.

  12. Nicole

    I just had umbilical cord stem cell injections in both knees 5 days ago. Last night I took excedrin migraine for a headache out of habit and realized after it has 250mg of aspirin in it. I obviously will never do this again. How serious of a mistake have I made. I’m very upset I did this. I’m trying to do everything right for this procedure to work.

    1. Chris Centeno Post author

      You’re fine as you were scammed. There is no such thing as an umbilical cord stem cell injection. These are all regulated by the FDA to be dead cell, non-viable products. Hence, you got no live stem cells injected in your knees.

  13. Jane

    For many (approx 15) years my ORTHO docs had me on most every NSAID from Celebrex to Voltaren, due to knee cartilage being removed after my knee got stuck (flamingo style). I was a very athletic woman & it took 3 episodes before I threw in the towel & allowed the meniscus, pluck band, etc to be removed sometime in the 90’s. In 2011, sarcastic surprise! I was diagnosed with kidney disease “due to NSAIDs.” My question is if the NSAIDS were that bad that now I am in stage 3 CKD, is that an indicator that my stem cells/cartilage would be of little help? I am 67 now.

    1. Regenexx Team

      Hi Jane,
      So sorry to hear that! This is unfortunately not as uncommon as one would think… Are you now off the NSAIDs and if so, for how long?

  14. Mark

    Good info. Exciting times but it’s the Wild West and takes a lot of care and discretion to not be misdirected Oe exploited.

    I’d be very grateful if you would clarify whether curcumin – which looks to have a lot of tremendous medical virtues – is safe to take following a stem cell procedure. Could it’s anti inflammatory effects interfere with implanted stem cell chondrogenesis? Is there a period of not taking it following a procedure?
    Thanks
    Mark

    1. Regenexx Team

      Hi Mark,
      We can’t comment on other stem cell procedures, or Curcumin in general which is why we put a year’s worth of lab research developing our own supplements. Please see: We recommend that our patients take our Advanced Stem Cell Support formula, which contains Curcumin, before and after a Regenexx SD stem cell procedure. Please see: https://regenexx.com/blog/stem-cell-supplements/

  15. chris a frazier

    Hey,
    In feb. 18 had surgery on outer side of left ankle to debride bad cartlidge and tighten the ligament in same area. Aug.18. I had another surgery caused mri showed torn longus bevis tendon . 50% removed and diseased. Also had artho on cartlidge of talus(necrosis)to remove 30% microfracture done both times. 4mths after still having pain. Had stem cell,adipose, and prp @regenexx on jan1 2019. Im 46days post procedure. Show signs of improvement at 4 weeks now back to pain again. Tylenol is noneffective. I take every bone, collagen supplement possible. I have stiffness and pain when walking . My stem cell Dr. Gave me tramd. For pain but it has very little effectiveness with major headaches. The only relief i get is from 800mg ibuprofen. Im going next week, to be tested for psoriatic arthritis. I know the nsaids intefere with stem cells, I also have celebrex I can take but it will also interfere. At this point, I was just wandering if you might have any suggestions? Im throwing a complicated case at you, but Im just searching for answers and im anxious at this point to get back to work with minimal pain. Any advice would be awesome.
    Thanks
    Chris F.

    1. Regenexx Team

      Hi Chris,
      We’d need a phone review to advise. Please call 855 622 7838 to set that up.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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