“What have you done to try to get better?” This is one form of a question I always ask patients who come to my office for a sports- or exercise-related injury. I’m trying to determine if they have tried to rest the affected body part, used ice or compression bandages, or tried physical therapy. The most common response is, “I’ve been taking ibuprofen.” Or naproxen. Or acetaminophen or other pain medications.
The use of over-the-counter pain medicines among athletes and weekend warriors is not new. In fact, athletic individuals take these medications without consulting a doctor very frequently. It has been reported that half of Americans over the age of 18 have used over-the-counter pain medicines in the past six months.
A study in the January/February 2011 issue of Sports Health by Douglas A. Wolf et al. looks at the use of these drugs among college football players. The authors administered surveys to football players at eight NCAA Division 1 colleges. Their findings suggest that athletes use these medications frequently, often without supervision, and often at much higher than recommended doses.
The authors found that these college football players used nonprescription pain medicines, including ibuprofen, aspirin, acetaminophen, and naproxen, at a much greater rate than the general population. 37% of the players used more than the recommended dose. 64% decided to use the medications themselves rather than at the suggestion of a physician or athletic trainer.
Interestingly, there seemed to be several misconceptions of the medications among the athletes. 36% of those athletes who took more than the recommended dose believed that taking more would make the pain go away faster. 89% of them took more because they thought that they needed higher doses due to their larger sizes. (Adult doses are not based on body weight.) And 41% of athletes took the medications because they expected pain after activity, while 31% took them to avoid missing practice or a game.
The authors concluded that misuse of nonprescription pain medications is frequent among NCAA football players. They recommend education of players and coaches by physicians in order to decrease the chance of athletes taking higher than recommended doses or taking them to prevent anticipated pain or avoid missing practices or games.
Now I realize that almost none of the readers of my article are NCAA football players, but I do think that the study brings up some important points for all athletic individuals.
First of all, I would agree that anti-inflammatory medications (NSAIDs), such as ibuprofen or naproxen, are to be used short-term to treat acute pain and swelling. In my opinion, they shouldn’t be taken for months on end. These drugs might be available without a prescription, but they do have side effects. For the most part they are safe, but they are associated with GI issues like heartburn and ulcers, high blood pressure, kidney problems, and cardiovascular events.
If an athlete or weekend warrior needs one of these pain medications for more than 10 days or so, he or she should consult a physician. Proper education might decrease the chance of taking too much of them. Plus the physician might be able to recommend treatments that might not only decrease inflammation but also treat the underlying problem, such as rehabilitating with a physical therapist. Finally, if pain persists despite ice, compression, avoiding offending activities, and yes, over-the-counter pain medicines, then a sports medicine surgeon unfortunately might be needed to fix structural damage of a bone or joint.