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<div class="editorbox"> '''Original Editor '''- [[User:Lucindahampton|Lucinda hampton]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
= '''Introduction'''&nbsp;  =
= '''Introduction'''&nbsp;  =
[[File:Pain med.jpeg|right|frameless]]Analgesics are widely used in sport to treat [[Pain Medications|pain]] and [[Inflammation Acute and Chronic|inflammation]] associated with injury. However, there is growing evidence that some athletes might be taking these substances in an attempt to [[Effects of Performance Enhancing Drugs|enhance performance]]. While the pharmacological action of analgesics and their use in treating pain with and without anti-inflammatory effect is well established, their effect on sport performance is debated.


Analgesic medication is a category of drug that is meant to cause the cessation of pain within an individual. Because of the effect that analgesics have on the body, these types of medication are more commonly referred to as painkillers. They can come in both prescription form and over-the-counter form and are typically used by individuals who have experienced some type of injury or who suffer from painful diseases. <br>As with all medication, there are positives and negatives associated with the usage of analgesic medications.  
== Effects on Performance ==
* Acetaminophen (paracetamol) has been suggested to improve endurance and repeated sprint exercise performance by reducing the activation of [[Cerebrum|higher brain structures]] involved in pain and cognitive/affective processing.
* Non-steroidal anti-inflammatory drugs ([[NSAIDs in the Management of Rheumatoid Arthritis|NSAIDs]]) affect both central and peripheral body systems, but investigation on their ergogenic (ie enhances physical performance) effect on muscle strength development have provided equivocal results.
* The therapeutic use of [[Corticosteroid Medication|glucocorticoid]]<nowiki/>s is undoubtable and clear evidence exists for a performance enhancing effect following short-term oral administration.
* There is a paucity of research on the use [[Opioids|opioid]]<nowiki/>s such as tramadol on sporting performance
Based on the evidence the ergogenic benefit of analgesics may warrant further consideration by regulatory bodies <ref>Holgado D, Hopker J, Sanabria D, Zabala M. Analgesics and sport performance: beyond the pain-modulating effects. PM&R. 2018 Jan 1;10(1):72-82. Available from: https://www.researchgate.net/profile/Darias-Holgado/publication/318722082_Analgesics_and_Sport_Performance_Beyond_the_Pain_Modulating_Effects/links/5c18013ca6fdcc494ffc5d80/Analgesics-and-Sport-Performance-Beyond-the-Pain-Modulating-Effects.pdf?origin=publication_detail (accessed 20.3.2021)</ref>. NSAIDs and paracetamol are sold over-the-counter and are currently not classified as doping agents. The use of over the counter analgesic drugs is commonplace in elite sports as well as in recreational and student-athletes and is is much higher in Olympic athletes compared with age-matched controls.
== Athletic Performance and Analgesics ==
[[File:Athletes.jpeg|right|frameless|400x400px]]
There is emerging evidence that paracetamol might acutely improve important endurance parameters as well as aspects of neuromuscular performance, possibly through increased pain tolerance.
* Both NSAIDs and acetaminophen (paracetamol) are used to reduce short term pain and inflammation, they have also been shown to modulate [[muscle]] [[Muscle Function and Protein|protein]] turnover through the effects on the cyclooxygenase (COX) [[Enzymes|enzyme]] pathways. NSAIDs have been reported to interfere with muscle hypertrophy and strength gains in response to chronic [[Strength Training|resistance]] training in young individuals<ref name=":0">Lundberg TR, Howatson G. [https://www.revdesportiva.pt/files/para_publicar/Analgesic_anti-inflammatory_drugs_sports_Implications_exercis.pdf Analgesic and anti‐inflammatory drugs in sports: Implications for exercise performance and training adaptations]. Scandinavian journal of medicine & science in sports. 2018 Nov;28(11):2252-62.Available from: https://www.revdesportiva.pt/files/para_publicar/Analgesic_anti-inflammatory_drugs_sports_Implications_exercis.pdf (accessed 20.3.2021)</ref>. Collectively studies suggest that both ibuprofen and paracetamol have the potential to modulate early signaling responses that regulate muscle protein turnover.
* It appears NSAIDs have the capacity to interfere with the normal myogenic stem cell ([[Satellite Cell|satellite cells]]) response to acute exercise bouts.
Athletes reported that they used NSAIDs to reduce pain and inflammation associated with training, competition or soft tissue injuries, or to gain a competitive advantage. The high use of analgesic drugs takes place despite the fact that most sports organizations declare that unnecessary medication should be minimized due to potential short- and long-term adverse effects.


<br>  
The benefits of taking analgesics to reduce exercise-induced pain look to be very limited indeed, and the risk of potential unwanted side-effects appears to be high, particularly when the doses are higher and prolonged. Even though present data indicate an attenuated training response, support exists at least for paracetamol to potentially enhance performance capacity. Consequently, there are reports strongly advocating that paracetamol should be added to the WADA doping list<ref name=":0" />.


= '''Effects on Activities of Daily Living (ADLs)&nbsp;&nbsp;''' =
== What is New ==
# There is emerging evidence that ingestion of paracetamol might enhance important endurance parameters as well as aspects of [[Neuromuscular Adaptations to Exercise|neuromuscular]] performance, possibly through increased pain tolerance.  
# Analgesic drugs have been shown to reduce the anabolic response to acute exercise bouts and attenuate long-term gains in muscle mass and strength in young healthy individuals.
# While further studies are required to better unravel the consequences of using analgesic drugs in elite athletes, the current data call for greater awareness among coaches, medicine, and science support staff with regard to potential adverse effects and the associated ethical issues surrounding the frequent use of these drugs<ref name=":0" />.


One study set out to determine the effects of opioid usage on activities of daily living (ADL). The medication used in the study was the buprenorphine transdermal delivery system (BTSD), and this medication was evaluated for its effectiveness in helping patients with chronic low back pain (CLBP) perform ADLs. The results showed that those individuals with CLBP who wore the BTSD patch experienced a reduction in pain and a significant improvement in abilities to carry out ADLs <ref name="ADL">Miller K, Yarlas A, Wen W, Dain B, Lynch SY, Ripa SR, et al. The impact of buprenorphine transdermal delivery system on activities of daily living among patients with chronic low back pain: an application of the international classification of functioning, disability and health. Clin J Pain. 2014 Dec;30(12):1015-22.</ref>. The BTSD could benefit those who wish to implement a strengthening or stretching regime because it ultimately reduces pain and allows increased participation in ADLs.
==  '''References'''&nbsp;   ==
 
<br>
 
= '''Effects on Athletes'''&nbsp; =
 
Athletes often take analgesic drugs to relieve soreness after exercise. An uncommon positive side effect that can go along with using analgesic medication is increased time to exhaustion during exercise in the heat. The article by Mauger, A.R., Taylor, L., Harding, C., Wright, B., Foster, J., &amp; Castle, P.C. (2014) discusses how acute acetaminophen (paracetamol) ingestion improves time to exhaustion during exercise in the heat. Experimental physiology 99(1). p. 164-171, states that acute acetaminophen ingestion lead to significantly increased time to exhaustion when exercising in hot conditions. The authors hypothesized that this could occur because acetaminophen possibly decreases the thermoregulatory challenge that occurs when exercising in the heat. This can be useful information when working with athletes who have to compete in hot weather conditions.
 
A couple common analgesic drugs that can be found over-the-counter and are taken post-exercise are ibuprofen and acetaminophen. Although these drugs have been suggested to relieve muscle soreness after exercise, they may have negative physiological effects as well. Typically, after exercise, muscle protein synthesis increases, leading to hypertrophy of the involved muscles. In a study done by Trappe, White, Lambert, Cesar, Hellerstein, and Evans (2002), subjects who had consumed ibuprofen and acetaminophen post-exercise actually experienced weakened protein synthesis. These results suggest that long-term use of analgesic medications such as ibuprofen and acetaminophen may actually decrease the typical hypertrophy that follows eccentric training<ref>Trappe T, White F, Lambert C, Cesar D, Hellerstein M, Evans W. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. American Journal of Physiology 2002;282:551-6. http://ajpendo.physiology.org/content/282/3/e551.short (accessed 10 November 2015).</ref>. Therefore, if an athlete is trying to build muscle, he or she may not benefit from consistently taking analgesic drugs.
 
<br>
 
= '''Effects on Renal System&nbsp;''' =
 
Another important and less known physiological effect of analgesic medication on the body is that on the kidneys. Farquhar, Morgan, Zambraski, and Kenney (1999) suggested that it is safer to consume acetaminophen than ibuprofen because it has less severe renal effects. In individuals who had recently exercised, ibuprofen was more likely to decline renal function<ref>Farquhar W, Morgan A, Zambraski E, Kenney W. Effects of acetaminophen and ibuprofen on renal function in the stressed kidney. Journal of Applied Physiology 1999;86:598-604. http://jap.physiology.org/content/86/2/598.short (accessed 10 November 2015).</ref>. These findings suggest that it may not be safe to consume certain analgesic drugs during exercise to maintain the function of the kidneys so that an individual may avoid dehydration during exercise.
 
<br>
 
= '''Effects on Ventilation'''  =
 
Analgesic medications can have effects that are not immediately noticed. One analgesic drug in particular, morphine, has latent effects on ventilation. Researchers found that even though morphine may seem to have waned its effect on the bloodstream, it can still linger and compromise the ventilatory processes<ref name="May">May WJ, Henderson F, Gruber RB, Discala JF, Young AP, Bates JN, Palmer LA, Lewis SJ. Morphine has latent deleterious effects on the ventilatory responses to a hypoxic-hypercapnic challenge. Open journal of molecular and integrative physiology 2013;3:134-145</ref>. Specifically, even after the arterial blood-gas chemistry eventually reaches stability, morphine can inhibit minute ventilation and negatively alter ventilatory responses, especially in cases where oxygen or carbon dioxide levels change drastically<ref name="May" />. These effects can be devastating for a patient undergoing a rigorous exercise regimen and put him or her at potential risk for either hypoxia or hypercapnia.
 
<br>
 
= '''Additional Precautions'''  =
 
Although analgesic medications effects can relieve muscle soreness, another less known danger is the risk of addiction from opioids and other over-the-counter medications. According to a fact sheet from the Oklahoma government and the Centers for Disease Control and Prevention, deaths from opioid pain relievers have now surpassed deaths from cocaine and heroin <ref>http://ok.gov/odmhsas/documents/PR%20RxAbuse-FactSheet.pdf</ref>. Oklahoma ranks 9th in overdose rates in the United States and according to the 2009 National Survey on Drug Use and Health, Oklahoma ranks first in every age category for the consumption of nonmedical pain relievers. This statistic is noteworthy in the physical therapy professions. Many patients are post-operatively prescribed over-the-counter drugs, as well as generic analgesics like acetaminophen and ibuprofen. Apart from their exercise side effects, addictions to these drugs can bring cognitive impairment, psychomotor impairment and serious withdrawal symptoms with the end of long term prescriptions <ref>Zacny, J. P. (1995). A review of the effects of opioids on psychomotor and cognitive functioning in humans. Experimental and Clinical Psychopharmacology, 3(4), 432..</ref>. Cognitive impairment can bring dangerous side effects to exercise during therapy. It can increase the risk for falls or further injury, while withdrawal symptoms can include serious illnesses that make physical therapy difficult, if not impossible for such a patient.&nbsp;<ref name="(Lewis, 2015)">Lewis, T. (2015, November). The government is keeping track of these commonly prescribed drugs to help fight a major epidemic. Retrieved from www.businessinsider.com</ref>
 
[[Image:Opioid Death Rate.png|right|400x300px|This chart shows how death rates from opioid usage in America have increased over time.]]
 
= <br>'''References'''&nbsp;<br>  =


<references />
<references />
[[Category:Sports Medicine]]
[[Category:Pharmacology]]
[[Category:Exercise Therapy]]
[[Category:Physiology]]

Latest revision as of 05:54, 15 August 2022

Original Editor - Lucinda hampton Top Contributors - JayLynn Sperry, Lucinda hampton, Yen-Oanh Vo, Maddisen Coleman, Kim Jackson, Ashley Pittser, Kayla Garrett, Stephen Sheffield, Taylor Ledford, Robert Long, Emily North, Kayla Woods, Dayla Scales, Ryan Lester and Katie Sanders

Introduction [edit | edit source]

Pain med.jpeg

Analgesics are widely used in sport to treat pain and inflammation associated with injury. However, there is growing evidence that some athletes might be taking these substances in an attempt to enhance performance. While the pharmacological action of analgesics and their use in treating pain with and without anti-inflammatory effect is well established, their effect on sport performance is debated.

Effects on Performance[edit | edit source]

  • Acetaminophen (paracetamol) has been suggested to improve endurance and repeated sprint exercise performance by reducing the activation of higher brain structures involved in pain and cognitive/affective processing.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) affect both central and peripheral body systems, but investigation on their ergogenic (ie enhances physical performance) effect on muscle strength development have provided equivocal results.
  • The therapeutic use of glucocorticoids is undoubtable and clear evidence exists for a performance enhancing effect following short-term oral administration.
  • There is a paucity of research on the use opioids such as tramadol on sporting performance

Based on the evidence the ergogenic benefit of analgesics may warrant further consideration by regulatory bodies [1]. NSAIDs and paracetamol are sold over-the-counter and are currently not classified as doping agents. The use of over the counter analgesic drugs is commonplace in elite sports as well as in recreational and student-athletes and is is much higher in Olympic athletes compared with age-matched controls.

Athletic Performance and Analgesics[edit | edit source]

Athletes.jpeg

There is emerging evidence that paracetamol might acutely improve important endurance parameters as well as aspects of neuromuscular performance, possibly through increased pain tolerance.

  • Both NSAIDs and acetaminophen (paracetamol) are used to reduce short term pain and inflammation, they have also been shown to modulate muscle protein turnover through the effects on the cyclooxygenase (COX) enzyme pathways. NSAIDs have been reported to interfere with muscle hypertrophy and strength gains in response to chronic resistance training in young individuals[2]. Collectively studies suggest that both ibuprofen and paracetamol have the potential to modulate early signaling responses that regulate muscle protein turnover.
  • It appears NSAIDs have the capacity to interfere with the normal myogenic stem cell (satellite cells) response to acute exercise bouts.

Athletes reported that they used NSAIDs to reduce pain and inflammation associated with training, competition or soft tissue injuries, or to gain a competitive advantage. The high use of analgesic drugs takes place despite the fact that most sports organizations declare that unnecessary medication should be minimized due to potential short- and long-term adverse effects.

The benefits of taking analgesics to reduce exercise-induced pain look to be very limited indeed, and the risk of potential unwanted side-effects appears to be high, particularly when the doses are higher and prolonged. Even though present data indicate an attenuated training response, support exists at least for paracetamol to potentially enhance performance capacity. Consequently, there are reports strongly advocating that paracetamol should be added to the WADA doping list[2].

What is New[edit | edit source]

  1. There is emerging evidence that ingestion of paracetamol might enhance important endurance parameters as well as aspects of neuromuscular performance, possibly through increased pain tolerance.
  2. Analgesic drugs have been shown to reduce the anabolic response to acute exercise bouts and attenuate long-term gains in muscle mass and strength in young healthy individuals.
  3. While further studies are required to better unravel the consequences of using analgesic drugs in elite athletes, the current data call for greater awareness among coaches, medicine, and science support staff with regard to potential adverse effects and the associated ethical issues surrounding the frequent use of these drugs[2].

References [edit | edit source]

  1. ↑ Holgado D, Hopker J, Sanabria D, Zabala M. Analgesics and sport performance: beyond the pain-modulating effects. PM&R. 2018 Jan 1;10(1):72-82. Available from: https://www.researchgate.net/profile/Darias-Holgado/publication/318722082_Analgesics_and_Sport_Performance_Beyond_the_Pain_Modulating_Effects/links/5c18013ca6fdcc494ffc5d80/Analgesics-and-Sport-Performance-Beyond-the-Pain-Modulating-Effects.pdf?origin=publication_detail (accessed 20.3.2021)
  2. ↑ 2.0 2.1 2.2 Lundberg TR, Howatson G. Analgesic and anti‐inflammatory drugs in sports: Implications for exercise performance and training adaptations. Scandinavian journal of medicine & science in sports. 2018 Nov;28(11):2252-62.Available from: https://www.revdesportiva.pt/files/para_publicar/Analgesic_anti-inflammatory_drugs_sports_Implications_exercis.pdf (accessed 20.3.2021)
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