No pain, no gain or the world of malicious medication

My athletes have always had an open access to my medicine case and every kind of medications. True, from time to time I catch them ’stealing’ some sports drink powder in order to make their shakes sweeter but I interpret it as their pursuit of happiness.

However, after getting through a sleepless night worrying about a player who might have taken too many painkillers in order to relieve a serious toothache, I started to think how fragile the trust may be if one is in pain.

To illustrate, a former NFL player Ryan Leaf got arrested for burglary recently for repeatedly stealing painkillers from his acquaintances. In a recent study players who have been involved with the NFL were found to be more prone to abuse painkillers than the general population. Problems with pain medications are also known from other fields of sports. Almost 40% of players at the 2010 FIFA World Cup were taking pain medications prior to every game. Some teams even consumed over three drugs per player per game.

Magical pills

Analgesic drugs or painkillers, as the name suggests, are drugs which can relieve pain. Common drugs like aspirin and ibuprofen are also anti-inflammatory so they work on the redness, swelling, pain and tenderness. They block the chemicals that carry the pain signals from the injured point to the nerve.

What makes pain medication so attractive to athletes? In addition to easy availability, they are simple to use in the form of tablets, liquids, injections, patches etc; and most important: they work rather quickly to relieve the pain.

Although it is easy to suppress, pain is not just an annoying sensation impairing the performance. Pain is a part of the alarm system to warn that something is not working properly.

The darker side of pain medications

Typical side effects of pain medications can be nausea, vomiting, constipation, drowsiness and vision changes. However, this is not often experienced. The biggest problem that concerns injured athletes is prolongation of the recovery period as they choose to postpone the facing of the problem. Another issue is prophylactic intake of medicine, it suppresses the possible minor injuries and may lead to more drastic consequences.

Although only opioids can be physically addictive, reliance on the medication can still develop with milder forms of painkillers. Many athletes have described how safe they feel when taking the pills and how they need medication to perform better. Some sport scientists even claim that painkillers can be categorized as performance enhancers since some athletes use them during competitions and this action helps them to continue their performance beyond natural level.

Some years ago, possible harm to kidneys, liver and heart was fervently discussed. There were plenty of rumours about Croatian football player Ivan Klasnic and NBA star Alonzo Mourning who made a comeback to sports after kidney transplant and were thought to have suffered from the loss because of painkillers. After Mourning’s case, many players in the NBA started to avoid NSAIDs even if it was necessary.

Suggestions

The problem is not only in drug addiction. It is about excessive use that may not develop into addiction but is still unnecessary. Reasons for drug abuse can be different: perceived pressure from teammates, coaches or doctors; short career possibilities or competition season; competitiveness; rivalry; blind trust in medical staff etc.

In order to minimize the abuse of medications, different approaches can be used with the most radical being aggressive drug testing. Yet, there is a saying among the athletes that drug testing is like the IQ test – if you fail it, you are stupid. Therefore raising the awareness and explaining the working mechanisms of painkillers and giving information about safe intakes could be more beneficial. For example annual educational seminars are held in youth sports about steroids and other harmful drugs. However, painkillers are rarely mentioned even though they are probably 10 times more common in sports than steroids. Misuse of pain medication requires a prevention education just as any other problem in sport, such as knee injuries.

In addition, coaches and doctors should encourage athletes to treat their injuries and not return to training before complete recovery. Joachim Loew, the head coach of German national football team, has frequently stated during EURO 2012 that he only lets healthy athletes play and in case of doubt, injured player has to sit on the bench.

It is important to face and understand the pain in order to conquer it and become a better athlete. That is why medications can be hazardous– they will not let athletes understand their weaknesses and may leave an expression that the body has everything under control. Painkillers are and will remain important part of the sports medicine. I do not know an athlete, who would choose sitting on the bench instead of playing with pain under strong medications in the Olympic final. It is obvious that pain relievers should be used in order to help the athletes continue their performance during a temporary period of injury. Short-term use, if being controlled will not bring dangerous results. As coaches, doctors and physical therapists we have to educate athletes and keep in mind that they can be difficult to control when it comes to finding relief against pain.

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