Pain relief in a cup of tea

I took a fall skiing last week¹, my skis went in one direction, my knees in the other. The audible pop sounded and felt much like what happens when I break the cartilage in the joint of a chicken. Argh.

Not surprisingly my knee hurts (though it's not all that swollen compared to the time I tore the ligament in my ankle, where the swelling was quite spectacular). I'm taking ibuprofen for the pain. NSAIDs, such as aspirin, naproxen, and ibuprofen are effective antinociceptives² - painkillers. But I'm also adding a dollop of caffeine to each dose. It turns out that caffeine is an effective adjuvant for NSAID (non-steroidal anti-inflammatory drugs).

NSAIDs work by blocking the activity of prostaglandins, molecules that are used by the body in many signaling roles, including the signaling of pain. If the signal from my knee to the brain that says "pain" doesn't get through, it doesn't hurt (though it may still be hurt).

Adding around 100 mg of caffeine (roughly what's in my big mug of FTGFOP³ Assam tea) to 400 mg of ibuprofen makes it 2 to 3 times more effective in relieving acute pain. [Forbes et al. Clin Pharmacol Ther. 1991 49(6):674-84.] Onset of pain relief is faster and the duration is markedly increased as well. Caffeine appears to increase the availability of the NSAID at the signaling site.

So sitting by the fire with a cup of tea (and an ice pack on my knee) is soothing in more ways than one...

1. Full disclosure: I fell in the lift line, my skis got entangled when I tried to retrieve the pole that got stuck in the snow. I'd love to say I did this catching an edge on a glorious powder run.
2. The word nociceptive was coined in 1904 by Charles Scott Sherrington to try to disentangle the psychological perception of pain from the physiological response. Noci- comes from the Latin nocere - to harm (think noxious and innocuous)
3. FTGFOP, Finest Tippy Golden Flowery Orange Pekoe, a description of the leaves, Orange Pekoe has nothing to do with any particular flavor of tea, including orange!
4. Food Research International Vol 29, Nos 3-4, pp. 325-330.