Pain management in the athlete represents a great challenge.  From an athlete’s perspective, pain is a reminder that the body has not yet healed from an injury.  Athletes place an extraordinary amount of stress and demand on their bodies.  Pain can thus be a result of bone trauma, muscle strain, or a soft tissue / ligament injury.  Once the proper diagnosis is made, management should include medications, therapy, and appropriate use of injections.

When injured, there is often the desire to quickly return to sport for an important game or training session.  The physician may then be in a position to take the “Band-Aid approach”, using temporary measures such as a “shot of cortisone”, or prescribe painkillers to get an athlete through an important game.  This can lead to a vicious cycle of a short-term solution for a potential long-term problem.  Therefore in addition to medications, pain management should involve rehabilitation therapy to address proper healing and prevention of re-injury.

Typical medications prescribed for an athlete include nonsteroidal anti-inflammatories, especially the newer COX-2 agents.  These have a very potent effect on pain and swelling, without causing tolerance, dependence, or sedation.  Typically, these medications do not interfere with performance or alertness.  For soft tissue injuries such as muscle strains, there are new muscle relaxants that are effective, and do not cause sedation or dependence.

Narcotic pain medications are very effective for moderate pain, but have potential side effects. When prescribed, careful use of narcotic pain medications is critical in the athlete.  Narcotic pain medications often have central nervous system (CNS) effects, such as euphoria, or a “high,” which can lead to dependence with long-term use.  Typical narcotic medications include codeine, morphine, oxycodone, and hydrocodone.    Much like alcohol, narcotic pain medications can depress the CNS, and cause confusion, impaired coordination, loss of dexterity, depression, loss of concentration, and anxiety. Narcotics should only be used when prescribed by a physician.

There are numerous over-the-counter pain medications and compounds that are safe when used properly, but as harmful if not used carefully.  Tylenol© (acetaminophen) is often effective for moderate pain relief.  Generally physicians recommend a safe dosage of less than 4000 mgs. total per day.  Regular daily doses above that can lead to liver and kidney problems.  Many medications prescribed by physicians also contain acetaminophen, so one’s total acetaminophen dose may actually be higher than estimated.  There are numerous over-the-counter ibuprofen products on the market.  Typically, these contain 200mg of ibuprofen.  An injured athlete may be advised to take as much as 800 mg of ibuprofen three times daily.  Again, close physician monitoring is recommended, because high doses of ibuprofen may also lead to risk for kidney and liver problems, as well as gastrointestinal bleeding.

Pain management physicians are specialty trained to treat an injured athlete, and know the proper dosage of medications, potential side effects, and how to monitor the medications.  In addition, they prescribe physical therapy, topical medications, various alternative modalities, and perform injections.   With proper prescribing and monitoring, most pain medications are used safely and are effective.  When used improperly, pain medications may lead to “no pain” and “no gain.”