May 8, 2013
Painkiller Use Before German Marathon Resulted in More Adverse Effects

Erlangen, GermanySerious runners might bring in prescriptions for analgesics or purchase OTC products to try to prevent pain from interfering with their performance.

A new report published by the British Medical Journal, however, suggests why pharmacists and other health care professionals should caution about painkiller use before marathons and other challenging endurance sports.

“The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted [adverse effects] that increase with increasing analgesic dose,” according to the German researchers. “Analgesic use before endurance sports appears to pose an unrecognized medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.”

To find out what impact common analgesics could have on runners, the authors sent surveys to all 7,048 competitors in the 2010 Bonn Marathon/Half-Marathon about their use of medication and any symptoms they had during and/or after the race.

Surveys were returned by 56% of the participants, and most of those (87%) said they had run marathons before.

While 1% said they never use painkillers, one in five who reported taking painkillers before the race also said they used painkillers during training to control or avoid pain. In fact, 10% of the respondents said they were in pain even before the race began.

More than half of the drugs used (54%) were bought OTC without a prescription, and included diclofenac, asprin, and ibuprofen.

While use of painkillers appeared to make little difference in the numbers of runners forced to withdraw during the race because of pain and other health symptoms, withdrawal from competition because of gastrointestinal problems was significantly more common among those taking painkillers. Withdrawal as a result of muscle cramps, while rare, also was significantly more common in those who had taken these drugs.
Overall, the risk of experiencing health symptoms was 13% greater among runners who had ingested painkillers than those who had not. Symptoms included stomach cramps, cardiovascular problems, gastrointestinal bleeds, blood in the urine, and joint and muscle pain.

Of the runners who took painkillers, nine reported they had ended up in the hospital: three, who had taken ibuprofen, for temporary kidney failure; four, who had taken aspirin, for bleeding ulcers; and two, who had taken aspirin, for heart attacks; and one, who took aspirin, for mild foot pain.

None of the runners who competed without painkillers was admitted to the hospital, survey results found.

Furthermore, the rate of symptoms rose along with increasing drug dosages, according to the report authors, which was especially problematic because the runners often reported taking more than the recommended amounts. One in 10 of those using diclofenac took more than 100 mg; 43% of those who took ibuprofen, the second most popular choice, took doses of 800 mg or more—twice the recommended dose, according to the researchers.

The authors noted that painkillers block cyclooxygenases, which regulate the production of prostaglandins, and that prostaglandins protect tissues when the body is under extreme stress, such as during endurance sports.

“Taken together, our data indicate that the widespread use of cyclooxygenase inhibitors in connection with endurance sports is potentially damaging. Further investigations are warranted to examine whether the use of analgesics before and during sports activities should be avoided altogether,” the authors conclude.

U.S. Pharmacist Social Connect