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Abuse of painkillers in sport

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As Josef Zellweger, former gymnast medallist on men's rings at the European Artistic Gymnastics Championships used to say :

“(…) pain is an integral part of an athlete's life.

In constant search for performance, an athlete is likely to suffer ligament, tendon, bone or muscle damages during his practice. They result in an essential process for maintaining the Self integrity, the inflammatory response (IR). In addition to physiotherapy and a reduction in the intensity of training, or even a medical leave in the most serious cases, the prescription of anti-inflammatories by the sports medicine physician , allows a symptomatic but non-causal inhibition.

Anti-inflammatory drugs qualify or refer to substances that can fight inflammation. They are organized into two therapeutic families: steroidal anti-inflammatory drugs (SAIDs) and non-steroidal anti-inflammatory drugs (NSAIDs). They are known inter alia for their analgesic* and antipyretic* actions. They can be administered orally, dermally, intramuscularly or rectally as a suppository.

“We observe a consumption suffering from misuse, deleterious for the athlete’s health”

Today, linked with the level of practice, we observe a consumption suffering from misuse, deleterious for the athlete's health. In a study of 563 student athletes from two US universities, 29% used NSAIDs prophylactically before a competition. A potential performance gain according to the athletes was also mentioned. In 2016, during the Grand Raid in Reunion Island, 35.8% (n=409) of the ultra-trailers who participated in the study reported consuming NSAIDs during the year, of which 31.5% (n=129) used NSAIDs without a medical prescription. 30.7% (n=1142) of respondents were neither aware of the properties of NSAIDs other than analgesic and anti-inflammatory, nor of the risk of complications other than digestive and/or renal. These studies show a lack of knowledge by athletes regarding the use of anti-inflammatories. However, the effects on the body are not negligible such as exacerbated renal complications on a dehydrated subject, serious infectious complications, addictions risks related to addiction and hepatic complications. In France, drug poisoning is the leading cause of liver transplantation. As explained by the French National Agency for Medicines and Health Products Safety (ANSM) in its report in 2015, France was the second largest consumer of NSAIDs (paracetamol and aspirin) among seven other European countries (Germany, Italy, Spain, United Kingdom, Denmark and Sweden) and the fourth user of SAIDs (opioid).

These figures support the importance of a framework on pain management. In January 2020, ANSM decided that all drugs containing paracetamol and some NSAIDs would no longer be self-serve in pharmacies in order to allow a proper use of drugs and a strengthening of prevention.

"Self-medication is a common practice among athletes"

Self-medication from drugs for which prescription is not mandatory from and old prescribed but not consumed drugs is a common practice among athletes. Self-care without the advice of a medical prescriber is not without consequences. Other risks include impaired performance and unexpected positive doping control. On the current market, manufacturers have understood the problem and wish to propose natural alternatives with recognized therapeutic effects based on scientific studies. Even if the use of anti-inflammatories is useful, athletes need to be aware that it is not their only available option. While being accompanied by a health professional, being open to a healthier diet and lifestyle and curious about the benefits of plants should also be part of the care process.

Pauline Bastide, Dietician/Nutritionist Sport & Green

 

Glossary - Analgesic : all physical or medicinal means capable of alleviating pain. - Antipyretic : used to prevent or treat fever 

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