The use of pain killers (NSAIDs) in athletes: How large is the risk?

Daniel Fitzpatrick; Todd Leckie; Gunnar Heine; Luke Hodgson

doi:10.1016/j.jsams.2024.11.010

The use of pain killers (NSAIDs) in athletes: How large is the risk?

J Sci Med Sport. 2024 Nov 28:S1440-2440(24)00585-1. doi: 10.1016/j.jsams.2024.11.010. Online ahead of print.

Authors

Daniel Fitzpatrick¹, Todd Leckie², Gunnar Heine³, Luke Hodgson⁴

Affiliations

¹ Institute of Sport, Exercise and Health, University College London Hospitals, London, United Kingdom; Brighton Marathon Research Group, United Kingdom of Great Britain and Northern Ireland; University of Brighton, United Kingdom of Great Britain and Northern Ireland; Harlequins FC, Twickenham, London, United Kingdom; United Kingdom Exertional Heat Illness Advisory Group, United Kingdom. Electronic address: [email protected].
² Brighton Marathon Research Group, United Kingdom of Great Britain and Northern Ireland; Department of Intensive Care, University Hospitals Sussex, United Kingdom of Great Britain and Northern Ireland; Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland; United Kingdom Exertional Heat Illness Advisory Group, United Kingdom. Electronic address: https://twitter.com/todd_leckie.
³ Department of Nephrology, AGAPLESION MARKUS HOSPITAL, Germany. Electronic address: https://twitter.com/gunnar_heine.
⁴ Brighton Marathon Research Group, United Kingdom of Great Britain and Northern Ireland; Department of Intensive Care, University Hospitals Sussex, United Kingdom of Great Britain and Northern Ireland; Brighton and Sussex Medical School, United Kingdom of Great Britain and Northern Ireland. Electronic address: https://twitter.com/drlhodgson.

PMID: 39665963
DOI: 10.1016/j.jsams.2024.11.010

Abstract

Nonsteroidal anti-inflammatory drug use is prevalent in sport however the risk associated with their use in athletes is not well-understood. This review discusses the pharmacology of nonsteroidal anti-inflammatory drugs and the prevalence of their use in different sports and factors driving this. Use is very high in sports such as professional football and is sometimes by routine without indication and without medical supervision. However there is a paucity of evidence in other sports. There is good evidence for use of nonsteroidal anti-inflammatory drugs following an acute injury but they may prevent normal tissue healing and remodelling if used longer term for musculoskeletal injuries. There are well-known risks of cardiac, gastrointestinal and renal side effects but little specific data for athletes. Renal events are discussed in detail including the cumulative effect that nonsteroidal anti-inflammatory drug use, dehydration and concurrent illness can have to produce significant renal and systemic insult. We then discuss a pragmatic prescribing model enabling clinicians to utilise the beneficial effects of these medications whilst minimising risks.

Keywords: Cardiac; Gastrointestinal; Ibuprofen; NSAID; Renal; Sport.

Publication types

Review