Prescribe Physiotherapy to Save the Oceans! . . .?

Banerjee and Maric point out that non-steroidal anti-inflammatory drugs (NSAIDs) accumulate in fish, causing immune compromise, stunted growth, and significant reductions in egg production and hatching.2,3 NSAIDs are having similar effects on gastropods, bivalves, and crustaceans.

Resultantly, the United Nations Environment Programme and UNESCO have cited pharmaceuticals in oceans as part of their UN Agenda 2030 Sustainable Development Goals.4 NSAIDs account for more than 15% of all pharmaceuticals detected in aquatic environments.5 The drugs reach nature through human excrement. They prove highly resistant to biodegradation and flow into surface water from the effluent of water treatment plants.6 Who is taking and subsequently excreting all these drugs into our environment? The vast majority of NSAIDs are consumed as part of over-the-counter, self-medication for management of chronic or recurring pain.7

While the environmental concerns surrounding this behaviour receive less publicity, healthcare providers know well the direct, human adverse effects such as significantly increased risk of hearing loss,8 gastrointestinal bleeding,9 renal impairment,7 etc. Fortunately, one solution seems readily available. Banerjee and Maric note that research suggests physiotherapy can reduce the need for analgesics across a wide range of complaints. In one study of chronic knee pain, patients who did not receive physiotherapy demonstrated as much as three times more NSAID use.10 Physiotherapists can work with patients to find individualized ways to effectively manage or eliminate chronic pain. This can include taping, bracing, education and strategies, exercise therapy, manual therapy, thermotherapy, and much more. 

Of course, reducing pharmaceuticals in aquatic environments and non-pharmacological management of chronic pain would be only one, small, theoretical approach to the much larger problem of threats to marine life. However, multifaceted problems may require multifaceted solutions. Physiotherapy stands out as a solution that is immediately available and in the patient’s best interest. Patients who report long-term, self-medication for pain should be considered for physiotherapy. Protecting the environment serves as one reminder. 

 

References

1. Banerjee S, Maric F. Mitigating the environmental impact of NSAIDs-physiotherapy as a contribution to One Health and the SDGs. European Journal of Physiotherapy. 2023 Jan 2;25(1):51-5.

2. Świacka K, Michnowska A, Maculewicz J, Caban M, Smolarz K. Toxic effects of NSAIDs in non-target species: a review from the perspective of the aquatic environment. Environmental Pollution. 2021 Mar 15;273:115891.

3. Tyumina EA, Bazhutin GA, Cartagena Gómez AD, Ivshina IB. Nonsteroidal anti-inflammatory drugs as emerging contaminants. Microbiology. 2020 Mar;89:148-63.

4. Online resource available at: https://www.unep.org/news-and-stories/story/drugged-waters-howmodern-medicine-turning-environmental-curse. Last accessed 2023, March 7.

5. Vidal‐Dorsch DE, Bay SM, Maruya K, Snyder SA, Trenholm RA, Vanderford BJ. Contaminants of emerging concern in municipal wastewater effluents and marine receiving water. Environmental Toxicology and Chemistry. 2012 Dec;31(12):2674-82.

6. Luo Y, Guo W, Ngo HH, Nghiem LD, Hai FI, Zhang J, Liang S, Wang XC. A review on the occurrence of micropollutants in the aquatic environment and their fate and removal during wastewater treatment. Science of the Total Environment. 2014 Mar 1;473:619-41.

7. Doomra R, Goyal A. NSAIDs and self-medication: A serious concern. Journal of Family Medicine and Primary Care. 2020 May;9(5):2183.

8. Curhan S, Eavey R, Shargorodsky J, et a. Analgesic use and the risk of hearing loss in men. Am J Med. 2010; 123 (3): 231-237.

9. Huang ES, Strate LL, Ho WW, Lee SS, Chan AT. Long-term use of aspirin and the risk of gastrointestinal bleeding. Am J Med. 2011 May;124(5):426-33.

10. van Linschoten R, van Middelkoop M, Berger MY, Heintjes EM, Verhaar JA, Willemsen SP, Koes BW, Bierma-Zeinstra SM. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ. 2009 Oct 20;339.