Treating Pain in the NFL

National Football League task force sets recommendations for pain relieving drug use.

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) With football season in full swing, there bound to be aches and pains amongst the athletes. The use of a group of drugs similar to ibuprofen to manage and prevent pain is common in the National Football League (NFL).

About 20 percent of athletes using non-steroidal anti-inflammatory drugs (NSAIDs) report side effects, indicating a need for further investigation of its use.

The NFL Team Physicians Society developed a task force to determine how to best use Ketorolac tromethamine, a NSAID commonly marketed under the trademark Toradol and used to treat players.

The task force considered existing medical information, properties of the drug, reasons for using or avoiding the drug, and the NFL environment to determine these guidelines.

"Pain medication use for sports should be physician monitored."

Ketorolac is a potent pain and inflammation reducer that can be administered orally, intravenously, intramuscularly or through the nose.

The main uses of Ketorolac are to treat minor sprains and strains, injuries from muscle overuse and for post surgery recovery. In the NFL, it is commonly used for musculoskeletal injuries and to prevent soreness after a game.

A 2002 study revealed six adverse reactions across 30 NFL teams. These reactions included four muscle injuries, one gastrointestinal complaint and one case of post injection soreness.

These side effects seem minor in occurrence and severity. This may be due to a relatively high overall health level amongst athletes.

However, it is believed that use of Ketorolac in the NFL has increased since the study’s publication.

Dr. Dan Clearfield, D.O, a Board Certified physician in Family Medicine & Osteopathic Manipulative Medicine as well as Primary Care Sports Medicine has seen the use of Toradol in many pro teams and pro organizations. He’s also noted a large movement in sports medicine to reduce NSAID use.

“Prophylactically treating pain is one thing, but the use of an NSAID for this purpose is not the best choice,” said Dr. Clearfield. “This is because the initial inflammation, which the NSAIDs by definition block, is a necessary step for tissue repair after injury.”

Taking NSAIDs after injury can lead to prolonged recovery because there could be blocking of the initial inflammatory repair process.

“There are also potential risks of bleeding, acute kidney injury, and gastritis (upset stomach) with the use of NSAIDs, so their use as a prophylactic measure is not ideal due to the potential risks,” adds Dr. Clearfield.

The task force recommended that Ketorolac only be administered to prevent or reduce pain during and after pain. It should be used under supervision and on the order of a team physician.

Its use should only be used for diagnosed injury or conditions and should be included in injury reports.

The amount of Ketorolac administered should be the lowest effective dose since there is no evidence that higher doages work better for larger players. Its use should not be for longer than five days.

The NSAID should be taken orally since it has a faster onset when taken orally and lasts a similar amount of time to when it is injected. Injection of Ketorolac should be reserved for special circumstances.

Other NSAIDs should not be taken concurrently and Ketorolac should not be used in those with past allergic reactions to NSAIDs, gastrointestinal bleeding, renal compromise or past reactions.

The recommendations of the task force were published in the September/October issue of Sports Health: A Multidisciplinary Approach.
 

Reviewed by: 
Review Date: 
September 19, 2012
Last Updated:
September 19, 2012