Painkillers in sport

[mattc]

http://www.bbc.co.uk/sport/40056765

Being repeated right now on R4

[Greenbank]

Thanks, had forgotten I wanted to listen to it.

All of the recent stuff I've read has pretty much stopped me using Ibuprofen completely, and definitely for any endurance stuff.

Also, iplayer link: http://www.bbc.co.uk/programmes/b08rq745

[Greenbank]

It was mostly on painkillers being used to cover up injuries, leading to those injuries getting much worse.

Several people interviewed to say they take a couple of ibuprofen before a long run or ride as a matter of habit rather than necessity. I hoped the programme was going to go into more detail about this, as this was the part that interests me. I've seen several comments about how this can lead to other medical problems:-

e.g. http://brightonmarathonweekend.co.uk/medical-advice/

"
You should also be very careful to avoid NSAID medications whilst training and racing. Drugs such as larger doses of aspirin, voltarol (diclofenac) and ibuprofen (e.g Nurofen) can cause kidney problems when combined with high intensity exercise, and in very rare cases can affect bowel function. If pain relief is required, please use paracetamol instead. Please discuss running the marathon with your GP if you take any of these medications regularly.
"

As I said above, I've pretty much stopped taking any ibuprofen (pretty much the only time I take it is for hangover relief).

[mrcharly-YHT]

And paracetomol is really, really bad for your liver. Take it consistently and for many people it *causes* headaches.

Painkillers are a bad idea to take 'as a matter of course'. They should be used as an exception.

[citoyen]

Several people interviewed to say they take a couple of ibuprofen before a long run or ride as a matter of habit rather than necessity.

I admit to having done that in the past but I don't any more. I was wishing I had some ibuprofen at the end of Saturday's ride when my knee injury from January that I thought was cured by now flared up while grinding up a 20% gradient... but then maybe not having any painkillers prevented me riding hard enough to exacerbate the damage any further.

[rob]

I use ibuprofen post-event most of the time.   I carry them round multi-day rides and take a couple before a sleep break and it seems to help with recovery.

I can't say I feel massively guilty taking the odd ibuprofen during a ride or, indeed, the odd double espresso or pro-plus.

It's not like you're grinding up tramadol into a bidon in order to get through the end of a road stage.....

[Ben T]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it. If it's good enough for him it's good enough for me.
You obviously should learn to recognize how it affects your own digestion, and the difference between a niggle and an actual injury, however.

[mattc]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it. If it's good enough for him it's good enough for me.

ah, the eternal dilemma; who do you turn to for wisdom? Who can you trust?

Whose advice does one take on pharmaceuticals in sport: multiple monument winner and World Champion Tommy Simpson? Or an actual doctor who has spent decades researching the effects of chemicals on our body (but never won a bike race)?

Decisions decisions ...

[hellymedic]

I have not done any research and my medical qualification is decades old.

I take a few doses of ibuprofen if something BOTHERS me. Then I stop.

My small supermarket tablet packets are mostly past their expiry dates but I still take these tablets if needed.

I am not dead yet and have had no ill effects from this stratagem.

My total Vitamin I intake won't add up to much.

[Samuel D]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it.

Is Ibuprofen more harmful for under-35s?

Not that this matters to me. Since I’m not a professional athlete, I wouldn’t dream of taking painkillers for a sporting injury. For a start, the common ones make no significant difference to that sort of pain, in my experience of occasionally taking them for blinding headaches.

[hellymedic]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it.

Is Ibuprofen more harmful for under-35s?

Not that this matters to me. Since I’m not a professional athlete, I wouldn’t dream of taking painkillers for a sporting injury. For a start, the common ones make no significant difference to that sort of pain, in my experience of occasionally taking them for blinding headaches.

AIUI Ibuprofen is more dangerous in older people, as in 65+ but older folk have older organs and are frequently on other medicines, which may interact.

[DuncanM]

It used to be common in amateur American football in the UK to take significant amounts of ibuprofen. Then again, some of those guys had major knee issues and could barely walk without their pills...
Painkiller pills of any sort are a last resort for me now (I will use voltarol gel).

[Ben T]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it. If it's good enough for him it's good enough for me.

ah, the eternal dilemma; who do you turn to for wisdom? Who can you trust?

Whose advice does one take on pharmaceuticals in sport: multiple monument winner and World Champion Tommy Simpson? Or an actual doctor who has spent decades researching the effects of chemicals on our body (but never won a bike race)?

Decisions decisions ...

Tommy didn't die cos he took drugs, he died cos he didn't drink water.

[Ben T]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it.

Is Ibuprofen more harmful for under-35s?

Not that this matters to me. Since I’m not a professional athlete, I wouldn’t dream of taking painkillers for a sporting injury. For a start, the common ones make no significant difference to that sort of pain, in my experience of occasionally taking them for blinding headaches.

No, it's fine if they need it - they're just less likely to need it !

I think what he's saying is over 35s shouldn't put niggles down to "just getting old ", they're niggles that they probably still got when they were younger but recovered quicker from naturally , ibuprofen just speeds it up.

[Greenbank]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it. If it's good enough for him it's good enough for me.

ah, the eternal dilemma; who do you turn to for wisdom? Who can you trust?

Whose advice does one take on pharmaceuticals in sport: multiple monument winner and World Champion Tommy Simpson? Or an actual doctor who has spent decades researching the effects of chemicals on our body (but never won a bike race)?

Decisions decisions ...

Tommy didn't die cos he took drugs, he died cos he didn't drink water.

That may have been the understanding in 1967.

It would be interesting (and impossible) to investigate the circumstances of his death with the benefit of the advances in medicine, physiology and forensic pathology in the 50 years since.

[mattc]

Brad Gilbert says if you're over 35 don't even think twice about eating ibuprofen, just neck it. If it's good enough for him it's good enough for me.

ah, the eternal dilemma; who do you turn to for wisdom? Who can you trust?

Whose advice does one take on pharmaceuticals in sport: multiple monument winner and World Champion Tommy Simpson? Or an actual doctor who has spent decades researching the effects of chemicals on our body (but never won a bike race)?

Decisions decisions ...

Tommy didn't die cos he took drugs, he died cos he didn't drink water.

That may have been the understanding in 1967.

It would be interesting (and impossible) to investigate the circumstances of his death with the benefit of the advances in medicine, physiology and forensic pathology in the 50 years since.

Hey, if Ben wants to follow the Simpson road to sporting success - and ignore 50 years of medicine and physiology - that's fine. I wish him well!

[IJL]

And paracetomol is really, really bad for your liver. Take it consistently and for many people it *causes* headaches.

Painkillers are a bad idea to take 'as a matter of course'. They should be used as an exception.

Paracetamol is a very safe drug if taken at an appropriate dose, its risk to the liver is in overdose in which case the liver's supply of Glutathionine is depleted and a toxic conjugate is produced.

I would agree that taking analgesia as a matter of course to do sports is a bad idea, the occasional dose is a different matter.  Some people need long term regular analgesia for chronic problems and its often a matter of managing the risk.  Long term use of analgesia is not ideal but neither is long term pain.


[

[T42]

IIRC you can produce a "safe" paracetamol by including N-acetylcystine in the mix, but manufacturers didn't want to suggest that paracetamol was unsafe to start with.  People used to attempt suicide with aspirin so it was reckoned they'd be similarly chary of overdosing on paracetamol.

I do occasionally use paracetamol to relieve the pain of old injuries at the start of the season - later on, when the muscles toughen up, they don't complain unless I do something abnormal.

[Greenbank]

I would agree that taking analgesia as a matter of course to do sports is a bad idea, the occasional dose is a different matter.

What about the specific problem of an occasional dose (of an NSAID like ibuprofen) taken just before or during endurance or high-intensity exercise?

I was never one to chug down the Vitamin I (and never anything stronger), but I would often take a couple of ibuprofen (400mg in total) each morning of a multi-day ride (where I'd be riding 200km or more in a day). Not to numb existing (acute) pain to allow me to start, but as a 'preventative' to mask any future mild discomfort (sore legs or contact points). So, possibly 40 x 200mg ibuprofen in a calendar year. But it's the possible negative effects of even a low occasional dose when combined with subsequent exercise that I'm interested in.

I've all but stopped with ibuprofen. I'm doing a lot more running and (in my corpulent state) I didn't want to risk masking any pain as it's a lot easier to do lasting damage when doing weight bearing activity. I've been lucky so far and have been pretty much injury free (barring the odd niggle or blunt force trauma injury from playing 5-a-side football).

[IJL]

IIRC you can produce a "safe" paracetamol by including N-acetylcystine in the mix, but manufacturers didn't want to suggest that paracetamol was unsafe to start with.  People used to attempt suicide with aspirin so it was reckoned they'd be similarly chary of overdosing on paracetamol.

The paracetamol/ antidote combination was available in the past but It's not in the current BNF, I think it was methionine rather than n-acetylcystine which oddly enough is what was allegedly in Wiggins jiffy bag.

I think part of the resistance to using it would have been they are horribly smelly drugs, I used to prepare n-acetylcystine infusions and it reeked of rotten eggs, the oral methionine I only used once for a patient who refused the infusion and it caused nausea

[IJL]

What about the specific problem of an occasional dose (of an NSAID like ibuprofen) taken just before or during endurance or high-intensity exercise?

occasional is not going to cause any issues, unless you're high risk ie have cardiovascular issues or problems with reflux / gastritis/ renal issues  Used occasionally  NSAIDS cause few issues, however it only take 2-3 days of taking it three times per days to cause me to have gastritis. 

[Greenbank]

So you don't think there's any basis for the advice I've seen in some big events, e.g.

e.g. http://brightonmarathonweekend.co.uk/medical-advice/

"
You should also be very careful to avoid NSAID medications whilst training and racing. Drugs such as larger doses of aspirin, voltarol (diclofenac) and ibuprofen (e.g Nurofen) can cause kidney problems when combined with high intensity exercise, and in very rare cases can affect bowel function. If pain relief is required, please use paracetamol instead. Please discuss running the marathon with your GP if you take any of these medications regularly.
"

[IJL]

The key bit is the "larger doses" used sparingly there shouldn't be any issues. however I'm not sure how effective these meds will be used before exercise, I would be also be careful about using then in training, if it hurts enough to need them then in training then rest is a better option, pain is often a message to take it easy for a while, this is more so for those of us with a few more miles on the clock.

I can recall reading of problems related to NSAIDS in the sports medicine journals, there are people who take massive doses which can cause very significant issues, The occasional 200mg of ibuprofen is unlikely to cause much problem.

[Samuel D]

The occasional 200mg of ibuprofen is unlikely to cause much problem.

Or much benefit, I would have thought.

Having observed many people take painkillers, I think typically the main benefit is psychological.

If something hurts when you do it, stop doing it! No-one’s handing out prizes for gallantry.

[hellymedic]

Nobody's handing out medals for gallantry and I don't do suffering as part of my religion.

If I am troubled by pain when doing little or my normal activities, I take painkillers and am happier and more useful as a result.

That is their purpose.