There is limited data relating to the efficacy and safety of pain relief in elite athletes. There is however widespread use of analgesics in this group, highlighting a need to exercise caution when prescribing these medications.
This literature review looked to identify the usage frequency and effect of pain medications by elite athletes, with the view to developing evidence-based recommendations for the use and prescribing of analgesics in elite athletes and to guide anti-doping policy.1. A total of 70 publications were included for analysis. Most of these publications (n=45) focused on how often these medications are used by athletes. A smaller number of the included studies looked at the outcomes of using pain medications, however these suffered from small sample sizes and a lack of control groups. There was a general lack of consistency in the methods used for data collection and for the reporting of analgesic use, which made reliable comparisons difficult. The results of this review clearly demonstrate the need for further research to adequately develop analgesic use guidelines for elite athletes.
Oral NSAIDs were shown to be the most commonly used medication. During international football tournaments oral NSAIDs were used by between 30-50% of all players. Other issues that were observed included athletes reporting having used multiple NSAIDs, multiple routes of administration, higher than recommended dosing and the use of NSAIDs for the prophylaxis of pain. Injectable NSAIDs, anaesthetics or corticosteroids appear to be less commonly used. Several studies reported that players sometimes felt pressure to use medications to allow them to return to play. As a result of these findings the review’s authors highlighted the need for education around safe analgesic use. This would ideally be done both at the team and individual level. Team doctors also have a clear responsibility to lead this education and to ensure safe prescribing.
1. Harle CA, Danielson EC, Derman W, et al. Analgesic Management of Pain in Elite Athletes: A Systematic Review. CJSM 2018; 28:417-426.