Commentary

Is it OK to take pain medicine in order to continue playing?

By Dev K. Mishra, M.D.

Several factors cause athletes of all levels to continue to play through pain: the warrior mentality, shame from showing weakness and letting others down, pressure from teammates and coaches, and the threat, imagined or real, of lost playing time.

For young athletes, is it OK to take pain medicine in order to allow you to continue playing?

This is a very tricky question without simple answers, but there are some general guidelines that we can look to.

Types of pain medicines
For most young athletes when we talk about “painkillers” or “pain medicine” we are referring to commonly available over-the-counter medications such as Tylenol, or anti-inflammatory painkillers such as aspirin, ibuprofen, or naproxen.

Additionally there are prescription injectable pain medications and prescription narcotics, which would need to be carefully supervised by a doctor. Those would typically be used only during the recovery phase from a serious injury or from surgery.

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Generally OK: occasional use for soreness
Let’s say that your team is starting off some pretty intense preseason training. It’s very common in this scenario to have aching muscles especially during the early days of training. At the end of the training session you should do a proper cool-down, you may want to apply ice, and when you get home in the evening it’s generally OK to take some anti-inflammatory medication such as ibuprofen to help you feel better.

Similarly, it’s common during the course of the season to have soreness or achiness in your muscles from continued play. As long as there’s been no real injury and as long as you would describe it as soreness, then that is another scenario where I would generally say it’s OK to take some pain medicine to help you feel better and continue playing.

Warning: if you can’t play without pain medicine then don’t play
If you find yourself in a situation where you absolutely have to have some type of ibuprofen, naproxen or other over-the-counter medication each time that you go out and train or play, then you are in a dangerous situation where you really need to seek medical help for this condition. There are real risks in continuing to play by relying upon usage of pain medication in this scenario. You may be masking the pain enough that you risk serious or permanent injury to an area, and there are risks to your stomach, liver, and kidneys from prolonged usage of many of these medications.

Ideally, I would want you to seek qualified medical help in this case. At the very least you need to take some time off from play, get yourself comfortable enough so that you don’t need the medication in order to return to play.

Never: narcotic pain medication
In our orthopedic sports medicine group at Stanford we see a lot of athletes of all levels of play, and in my 23-year career I cannot recall a single time where I prescribed a narcotic in order to allow a young athlete to take the field. The same is true for every single one of my partners, as well as all other responsible physicians that we know.

The problem though is that it is all too easy for a young athlete to obtain narcotic medications illegally. And the consequences can be disastrous.

Consider this true story: a star soccer player in Southern California collided with another player and injured her already hyperextended knee. A doctor prescribed the opioid Norco. She soon obtained another opioid called OxyContin from a friend, and ultimately started using and even dealing heroin. She introduced her brother to the drug, leading to his death from an overdose.

What’s the connection? According to the National Institute on Drug Abuse, opioids are a close cousin to heroin, to which the brain responds in the same way. Plus, heroin is cheaper than opioids; an 80 mg OxyContin can cost up to $100 a pill on the street, but according to USA Today, a multiple-dose supply of heroin goes for $45 to $60. This is really scary stuff.

Fortunately most of our young athletes will only have to deal with the “occasional use for soreness” scenario. But if you ever find yourself in a situation where you absolutely need the medication otherwise you won’t be able to play, get yourself to qualified medical help quickly.

Key Points:
• Over-the-counter pain relievers such as Tylenol or ibuprofen are commonly used to reduce pain and soreness from mild sports injuries.

• It’s OK for young athletes to occasionally use these medications for sports-related aches and soreness.

• If you ever find yourself in a situation where you must have the medication in order to be able to play, you should seek medical care.

• Never use a narcotic pain medication in order to help you take the field.

(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.)

6 comments about "Is it OK to take pain medicine in order to continue playing?".
  1. Richard Brown, June 29, 2016 at 9:08 p.m.

    I have a lot on this stuff. Some Doctors put kids in regular casts to keep them from comming back too soon.

    Pain is a good thing it lets you know when their is a problem. No pain you can do serious injury to an already a problem condition.

    Some anti inflammatory' sold over the counter can be very dangerous for a kid. Under 18 yr old.

    You do a preseason fitness test check do things involving all parts of the body. If injured do the part with those parts.

    This is from a friend of mine Gary Rue

    Pre-practice or pre-game to help me determine if the player can or
    should play.

    This test are mostly for lower leg or ankle injuries:

    PROCEDURE
    * Execute the tests on non-injured foot/leg first
    * After execise on injuried foot/leg compare results
    * 85% completed reps on the injuried appendage is generally a go for play

    TESTS
    Balance: single leg volley kick; 30 reps or loss of balance

    Strength: vertical jump test #1 - standing on one leg, maximum leap and
    land; vertical jump test #2 - standing on one leg, jump a consecutive series
    of 10 jumps on one leg

    Propriceptors:
    * single hop for distance (twice)
    * timed hop for 7 yards
    * cross over hop - hop over a line up and wide as far as possible, then
    back, then back again (player must maintain balance

    Coach looks for signs of injury in:
    * straight ahead running
    * backward running
    * side shuffles
    * Carioca
    * figure 8's
    * zig-zags with 45-60 degree cuts
    * shuttle runs"

    Coach looks for signs of injury in functional test with ball; various
    methods of passing (all parts of foot) and shooting. Distances should cover
    5 yards progressing to 30."

  2. Bob Ashpole replied, June 29, 2016 at 9:53 p.m.

    Very useful information. Thanks for posting.

  3. Bob Ashpole, June 29, 2016 at 9:52 p.m.

    Doctor: Excellent article on an important topic. Thank you.

  4. Leia Ambra, June 30, 2016 at 1:04 a.m.

    I believe that massage is much better for post exercise soreness. Motrin etc. have been associated with heart problems and reduced bone healing; they inhibit all prostraglandins, incl. the ones which help tissue healing, not just the ones which cause inflammation.

  5. Richard Brown, June 30, 2016 at 5:43 a.m.

    On post exercise a cool down is needed if you want less soreness later before you leave the field.By continuing to exercise, albeit
    at a lower intensity, during the cooldown, the blood will eventually be diverted away from the extremities and back to the viscera and other
    internal organs. Another reason to perform a cooldown is that muscle and blood lactic
    acid levles decrease more rapidly during execise-recovery than during a rest-recovery. Therefore, a cool down would promote faster recovery from
    the fatigue of exercise.

    As player I took a massage from the club masseur. I can't tell you his story he came to the US after WW2. They should make a movie about the guy.

    Professional dancers some take ice baths. I think I would have a heart attack while doing that.

  6. Ginger Peeler, June 30, 2016 at 3:48 p.m.

    Thanks, Richard...your comment on you and an ice bath is priceless! You helped make my day.

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