Analgesic Medication and Exercise

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

Introduction 

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.

• 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 effect on muscle strength development have provided equivocal results.
• The therapeutic use of glucocorticoids is indubitable, but 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 .

• NSAIDs (such as ibuprofen, indometacin, ketoprofen, naproxen, acetylsalicylic acid, and diclofenac) 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. It has been reported that the use of NSAIDs is much higher in Olympic athletes compared with age-matched controls.

Athletic Performance and Analgesics

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 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. 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 (satelitte 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.

What is New

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.

Influence of acetaminophen and ibuprofen in older adults

Evidence suggests that consumption of over-the-counter cyclooxygenase (COX) inhibitors may interfere with the positive effects that resistance exercise training has on reversing sarcopenia in older adults. However evidence from a 2010 Randomized Controlled Trial found:

• Drug consumption unexpectedly increased muscle volume and muscle strength to a greater extent than placebo, when controlling for initial muscle size and strength
• Over-the-counter doses of acetaminophen or ibuprofen, when consumed in combination with resistance training, do not inhibit and appear to enhance muscle hypertrophy and strength gains in older adults. The present findings coupled with previous short-term exercise studies provide convincing evidence that the COX pathway(s) are involved in the regulation of muscle protein turnover and muscle mass in humans.
• The short-duration training program and low COX inhibitor dose likely explain the discrepancy between that study and other findings (see previous).