ioc consensus on “pain medicaon” in sport …...kennedy mc (1999) mja medication non-steroidal...
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IOCconsensuson“Painmedica1on”insport2.4.November2016
Incidence and prevalence of analgesic use in elite sport: Overview of
literature review and methodology
IOC Consensus Meeting on Pain Management in Elite Athletes, November 2016
Wayne Derman, MBChB, PhD Chris Harle, PhD
John Orchard, MD, PhD
n=3,852Screening
Included
Eligibility
Identification
Recordsafterduplicatesremoved(n=3,668)
Recordsscreened(n=3,668)
Recordsexcluded(n=3,581)
Full-textarticlesassessedforeligibility
(n=87)
Full-textarticlesexcluded(n=28)
n=64
Recordsidentifiedthroughothersources(n=5)
0
10
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60
70
Supplements orMedication
Medication NSAIDS
WC 2002WC 2006WWC 2003WWC 2007U-20 2005U-20 2007U-17 2005U-17 2007
Theuseandabuseofpainkillersininterna1onalfootball:Datafrom6FIFAtournamentsforfemaleandyouthplayers-Aprospec1vesurveyP.Tscholl,N.Feddermann,A.Junge,J.Dvorak,AJSM2008
5 3
Medica1onsduringFIFACompe11ons,5’432players
Why do athletes take drugs?
legitimate therapeutic use performance continuation – fighting symptoms recreational / social use performance enhancement. à predominantly healthy Mottram DR (2005)
Kennedy MC (1999) MJA
Medication
Non-steroidal anti-inflammatory
Other analgesics
B2-Agonists
Injections corticosteroids
Psychotropic substances
NSAIDs in International Football – during one season
92%ofadultplayers75%ofyouthplayersuseNSAIDsperseason15%ofyouthplayersaredailyusersà prophylactic and systematical use?
Taioli E (2007) BJSM, Warner DC (2002) J Adolesc Health.
Narcotics
5-15% of the players take narcotics at night Highly depended on physician / team
Grobler LA (2000) CJSM
In- out competition
Team or single event success
Playing or being reserve in the match
Tscholl et al 2008 BJSM, Tscholl et al 2009 AJSM
No influence
Factors associated with increased use of medication
Team physician Geographic origin Age
Physical demand Female athlete
2002 FIFA World CupTM
22 out of 23 qualified players were using at least one painkilling agent prior to a match during the entire
tournament!
Factors associated with increased use of medication
Team physician Geographic origin Age
Physical demand Female athlete
Factors associated with increased use of medication
Team physician Geographic origin Age
Physical demand Female athlete
n.s.
*
* * *
* p<0.01
Factors associated with increased use of medication
Team physician Geographic origin Age
Physical demand Female athlete
More medication More painkillers
More b2-agonists More narcotics but less
myorelaxants
OveruseSyndromesareCommone.g.ShoulderImpingementSyndrome
Males(n=174)
Females(n=210)
Total(n=384)
Acetaminophen 10 19 29
NSAIDs60(33%) 80(38%) 140
AnaestheLc 0 10 10
Opioidreceptorantagonist 0 2 2
Dataderivedfrom384(M:174;F:210)declaraLonformssubmiQedatthe2013WorldSwimmingChampionshipsheldinBarcelona,Spain.
AnalgesicUseamongSwimmers
CauseofMostGamesMissed
PatellofemoralInflamma6on17.5%LateralAnkleSprains 8.8%KneeSprains7.4%LumbarStrains6.6%
#1
#2
#3
#4
DrakosMCetal.SportsHealth2010;2:284-290
ItcanbeassumedthatthereissignificantuseoffNSAIDstoaddresstheveryfrequentincidenceof
patellofemoralinflamma6onamongbasketballers.
NSAIDUseintheXVPanAmGames
.DaSilvaERetal.BrJSportsMed2011;45:91-94
MarijuanaUse(withinthelast12monthsNCAA)
24%!
25%!25%!
18%!18%!
17%!
10%!
15%!
20%!
25%!
30%!
35%!
2005! 2009! 2013!
Male!Female!
Author’s pain-related takeaways Tscholl, Junge, Vaso, Weber, Dvorak
“Professional football players—mostly healthy athletes—consume a considerable quantity of medication, especially non-steroidal anti-inflammatory drugs, prior to competition. These results are alarming.” 2008 (World Cup 2002/2006)
“Overuse of medication in man, women, U-17 and U-20 cause for alarm (2009, FWC, WWC, U-17, U-20 FWC)
“Lesson not learned” (FWC 2010)
“Is it part of the game for players and physicians?” FWC 2014
Compared to Rio 2016 data • Survey of 107 Olympic team physicians (Stuart et al.) • Prescribing behavior in last 12 months:
• Oral NSAIDs - over 80% of physicians
• Paracetamol/acetaminophen and topical NSAIDs – over 50% of physicians
• 24% of physicians report routine use in over 30% of athletes • As pain becomes severe …
• oral NSAIDs, paracetamol, and topical NSAIDs !
• oral opioids & injectables (NSAIDs, anesthetics, corticosteroids, opioids) "