Do NSAIDs hamper herniated disc resorption?

Question

NSAIDs are routinely prescribed to treat symptoms of a herniated disc (Mayfield Clinic):

Nonsteroidal anti-inflammatory drugs (NSAIDs) (NSAIDs), such as aspirin, naproxen (Alleve, Naprosyn), ibuprofen (Motrin, Nuprin, Advil), and celecoxib (Celebrex), are used to reduce inflammation and relieve pain.

However, the process of natural healing (resorption) of a herniated disc is thought to be facilitated by the immune system in response to inflammation (Pubmed):

It is generally thought that an immune response develops to the disc tissue and inflammation helps to remove the invading tissue. Evidence suggests macrophages and neovascularisation play central roles in the resorption of discs following prolapse. Macrophages which infiltrate the herniated disc express high levels of matrix metalloproteinases, and these have an important role in the natural resorption process. The new blood vessels have an important role as a passage into the degenerate matrix.

NSAIDs are known to suppress the immune system (Pubmed):

In conclusion, we report that a panel of widely used NSAIDs blunts antibody synthesis in human PBMCs and in purified B cells. Ibuprofen’s ability to reduce antibody production was concentration- and time-dependent and likely occurred via Cox-2 inhibition. Our results call for awareness regarding the consequences that NSAIDs can have on immunity.

So, do NSAIDs hamper the disc resorption process?

Answer 1

This answer is about the effect of NSAIDs and steroids on the resorption of disc herniation and pain.

There seem to be no clinical trials in which NSAIDs or other drugs would slow down the resorption of disc herniation. Results of in vitro studies suggest that steroids may be able to delay resorption, but NSAIDs less likely.

STEROIDS

According to the study Influence of cytokine inhibitors on concentration and activity of MMP-1 and MMP-3 in disc herniation (Arthritis Research & Therapy, 2009), the resorption of a disc herniation is enabled by the enzymes called matrix metalloproteinases MMP-1 and MMP-3. In the study, a steroid dexamethasone and a tumor necrosis factor inhibitor infliximab reduced the activity of MMP-3, which suggests that...

...at least under certain circumstances, the clinical use of these drugs may affect the resorption of disc herniation.

BUT

Such an effect was not reported after a foraminal injection of methylprednisolone [another steroid] in patients with sciatica, but was observed in a rabbit model using higher dosages.

According to another study Lumbar disc herniation regression after successful epidural steroid injection (Journal of Spinal Disorders & Techniques, 2002):

In conclusion, epidural steroid injections do not alter ultimate herniated nucleus pulposus regression.

According to this 2006 trial, intravenous steroids have a small and short effect on pain reduction. According to American Family Physician, 2008, epidural steroid injections can provide better short-term pain relief.

NSAIDS

Here's one 2013 study about the effectiveness of physical therapy on the healing of the herniated discs. At the end of the article there is a recommendation that looks merely as an opinion:

However, the use of NSAIDs (non-steroidal anti-inflammatory drugs) should be limited, as they inhibit the function of phagocytes and inflammatory cells, which initiate resorption of the hernia.

But in a study In vitro effects of non-steroidal anti-inflammatory drugs on cytokine, prostanoid and matrix metalloproteinase production by interface membranes from loose hip or knee endoprostheses (Science Direct, 2006), NSAIDs did not have any clear effect on the MMP synthesis, which suggests they should not delay the resorption of disc herniation.

Anyway, according to several systematic reviews, NSAIDs are not very effective in treatment of spinal pain (Annals of Rheumatic Disease, 2016 ; Cochrane, 2016).

From a larger perspective, medications, other conservative therapy and surgery do not provide better long-term (1-2 year) results than no treatment at all (BMJ, 2007).