52 replies to this topic

[PhysioLarry]

Hi all,

Thought it would be interesting to see what CR's take by way of medication to help get through events. See JustinS007's regime for the marathon.

I recently had a patient say he used 2 nurofen tablets at 30km into the New York marathon with good effect, and I'm aware that many comrades runners take Besenol during the run.

Please detail dosages if your'e adding to the thread and hopefully we can get a sports doc to comment...

regards

Larry

JustinS007, on Jan 23 2008, 08:19 PM, said:

Welcome to my world.

I've no idea what your cause or symptoms are, but I also have pain on the outside of the right knee. With me it's a little lower basically over the top of the fibula head. When I run for a while I get a sharp stabbing pain down into the outside of the calf. Docs / physio's etc. still don't know what it is for sure, but suspect ITBS or joint issue at the fibula head. I'm now into an intense (and costly) physio program.

Anyway, I have had this for about 6 months now. In the early stage I ran through it and here's where I can possibly give you some pain advice - assuming you have the same or similar thing (which you probably don't as there are so many things that can go wrong in and around the knee).

My advice is seek diagnosis and treatment before doing anything else, otherwise (like me) you run the risk of making it worse and prolonging recovery. However if (like me) you don't care about how long it takes to heal you just want to do the event (as was my thought prior to Melbourne Marathon last year) then ensure you have good padding in your shoes, take 2 x ibuprofen, 2 x paracetamol and 2 x diclofenac pills 30 minutes prior to the start of the event. Then at the 3 hour mark take the same again and no matter how bad the pain gets don't stop running. If you do, you won't be able to start again.

This advice is crazy and you shouldn't follow it. It's bad for your body and taking so many pain killers probably isn't good for your kidneys and liver, but in my case it did work and I got through the event. A bit slower than planned, but I got through. By God I was sore 2 hours after the event though and won't be adopting this strategy again. Just how badly do you want to run the event is the question....

Regards, Justin.

Edited by PhysioLarry, 28 January 2008 - 11:23 PM.

[phYx]

Once I took a couple of tramadol (not sure of exact dosage, was for unrelated injury), and I was flying down the streets! But I certainly don't recommend that. I don't understand why people bother taking 400mg ibuprofen or paracetamol, that rarely even gets rid of a headache for me. I take no pills to get me through a run. If I am in pain, it means I have an injury, and it serves me right for running in the first place.

[Gronk]

Hey Larry

Voltaren Rapid has helped me get through many a bad patch. Two with food before a race.

Edited by Gronk, 29 January 2008 - 08:28 AM.

[gogirl]

Hi Larry,

Normally I won't take anything at all. On Saturday I ran the Aus Day Fatathon and I twisted my ankle at about the 20km mark. Luckily for me another runner had some Nurofen handy. I popped two of them with a muesli bar and some water and walked for about 1km. I started running again after that and had no pain at all.

I think that in certain circumstances they can be useful. I wouldn't be using them daily though to get through races or to get out training.

[rodthehornet]

No injuries at the moment, but have developed a habit (sound like a user) of popping 2 Nurofen plus 30 mins prior to long run. I always carry some in my pack in case of problem similar to Gogirl.

A few months ago I was in a similar state to Innes that prompted this thread. I had ITB but was still trying to pump out long runs, trying to keep some sort of base for GNW. Did reach the stage of 2 at the start, 2 in the middle and on occasion 2 at the end.

Yes, you will castigate me, but it helped me deal with the pain. I did have a dehydration issue on my last long run at that time, but was more a combination of incorrect food, tough course, hot day and changing half way thru the run from cordial to plain water. I dont think the Nurofen played a part, but cant be sure.

In hindsight only rest and some work on the problem sorted it out.


Rod

[RossBris]

I have pretty crap cardio fitness at the moment, my doctor suggested I take a few puffs of some ventolin before a run, to open up my lungs - I know that technically in a tiny tiny dose that is a steroid but it opens my lungs up.

I had also been thinking about a few Mersyndol Forte's loaded with Codiene to kind of dope me into thinking my shins weren't hurting.

Ross...

[crazycatwoman]

RossBris, on Jan 30 2008, 08:09 PM, said:

I have pretty crap cardio fitness at the moment, my doctor suggested I take a few puffs of some ventolin before a run, to open up my lungs - I know that technically in a tiny tiny dose that is a steroid but it opens my lungs up.

I had also been thinking about a few Mersyndol Forte's loaded with Codiene to kind of dope me into thinking my shins weren't hurting.

Ross...

Ross, ventolin isn't a steroid it works by preventing the airways from spasming which is what happens during an asthma attack, so it does in effect open the airways. It also increases heart rate so don't be surprised if your heart rate is higher than normal after the medication.

[Tim 2]

I don't have any qualifications in sports medicine but am a doctor and a keen ultramarathoner.

I have always been concerned at the use of nurofen or other anti-inflammatories especially in long races/runs. In combination with dehydration (which is almost inevitable) these tablets greatly increase the chances of acute renal failure a very serious and potentially life threatening situation. Renal impairment is a known and common side effect of these drugs and i imagine a significant percentage of nurofen users who get dehydrated on a run will have a mild renal impairment which gets better when the rehydrate and stop taking the drugs. Acute renal failure is worst case scenario and is unlikely to happen to most of us but it will happen to someone in Australia one day (i've heard of it happening overseas). They will potentially need intensive care and dialysis at least for several days or weeks and potentially for the rest of their life. The risk is greatest in those with other kidney problems, which may not even be known to the person with them, and those with high blood pressure (especially those taking many of the common medications for this) or diabetes and older people (kidney function declines with age and you have less reserve). Asthmatics should be extra careful with anti-inflammatories because they can increase the likelihood of an asthma attack.

As for ventolin it is not a steriod although some other "puffers" do contain steriods (not of the anabolic kind). It is unlikely to do any harm in usual doses (increased pulse rate/palpitations if you take alot of it) but unless you have reactive airways and a tendancy towards mild asthma you're probably wasting your time and money using it. In other words it won't "open up" your lungs significantly unless there was some airway spasm/constriction present in the first place.

With opiates (codiene etc) their main side effects are drowsiness, dependence if overused and constipation. The other thing to bear in mind is that most codiene tablets are in combination with paracetamol which is toxic to the liver in overdose (safe level 4grams/day (usually 8 tablets)). Tablets with codiene in useful dosages all require perscription. Panadiene and similar have only a small dose of codiene and have little benefit over paracetamol alone except maybe the placebo effect.

In short i don't do painkillers on a run because i believe the risks outweigh the potential benefits. My advice would be make sure you understand the risks before you take anything.

Hope that helps

Tim

[Beki]

RossBris, on Jan 30 2008, 08:09 PM, said:

I had also been thinking about a few Mersyndol Forte's loaded with Codiene to kind of dope me into thinking my shins weren't hurting

Don't know if I'd advise that! I used to take them for migraines and could only take them at night because they really knocked me out

I have shin problems at the moment so it's a case of rubbing plenty of voltaren gel in, mind you it is getting slowly better. Most of the time I try to avoid taking anything. If I have to seriously dose up every time I go out then my body is telling me something. No need to mask the pain and cause an even worse injury by training through it... Listen to your bodies people! Nothing worse than an enforced lay off due to soldiering on

[undercover brother]

Tim 2, on Feb 1 2008, 08:14 PM, said:

I don't have any qualifications in sports medicine but am a doctor and a keen ultramarathoner.
I have always been concerned at the use of nurofen or other anti-inflammatories especially in long races/runs.

ditto.
and ditto.
i have never taken nsaids during a run and would 'almost never'.
i have taken paracetamol +- codeine twice : once when i hit my head on an extremely large tree

[milov]

Hey All,

I have got to admit that I have taken nsaids perhaps all too readily, and I am keen to stop taking them. I guess that you have to accept that sometimes some pain goes with the territory and I should learn to run smarter and not just harder.

Thanks Dr s Tim and UCB for the advice.

milo

[RossBris]

Thanks for the advice re the meds, and I note that it wasn't "OFFICIAL" advice, so if I collapse I wont sue you.

I have tried lately not using the ventolin, because I wondered whether it was more of a placebo than anything. My wife used it to try to jog with me, as she had difficulty breathing. I used it but I think that the fact that it pumps up the heart and pulse may trick my mind into thinking its working.

Regarding the Nurofen, I am always very carefull taking them, I was always told that Brufen (and related products) should only be taken whilst eating a meal and never alone, as they destroy the stomach lining. And since a full stomach and big meal is not a good thing before a run I don't think I will take them.

I have always found Codiene doesn't knock me out much at all, but it could be a dependance thing, I have 3 herniated discs in my back so had used codiene for quite a long time.

I like the simple not drug related idea of putting some voltarin gel on the legs before a run, I think I will give that a go and see if I get results.

Anyway thanks for the input.

Ross...

[jenny the orienteer]

RossBris, on Feb 2 2008, 04:42 PM, said:

I like the simple not drug related idea of putting some voltarin gel on the legs before a run, I think I will give that a go and see if I get results.

Dear all

Putting on my "pharmacist's hat" (gotta fund the running habit somehow) I'd point out that the Voltaren gel is indeed a drug and contains the same stuff as is in Voltaren tablets. So it, and Feldene gel, can still cause the excess bruising, heartburn, and possible asthma if you use too much of it too often.

Don't have any experience with taking tramadol or codeine containing products but if they don't space you out too much, or clash with any regular medications then are probably okay as a one-off for a race but not regularly for training. Remember that Panadeine and Panadeine Forte have paracetamol in them just like plain Panadol does and don't have more than 8 a day in total of anything containing paracetamol ( more than this can do bad things to your liver).

I try to stick to plain Panadol these days because the anti-inflammatories cause indigestion and fluid retention, but use the Voltaren gel when my ITB is truly unhappy, and do take Brufen/Nurofen throughout a 24 hour rogaine (and antacids afterwards)!

[JustinS007]

Hi Larry,

It's a good thread you've started.

I should point out that I only took this quantity of pills prior to the Melb. Marathon as I was determined to complete it. I'd never take so many meds in training. However, I do occasionally take 2 x ibuprofen (nurofen or equivalent) just before or during a run if my knee hurts. At the moment I am only running short distances (up to 10km) in order to fix the problem permanently and haven't had any meds whilst doing this. But for longer runs when I did them I found that the ibuprofen allowed me to get much further into an event or a training session before the pain would kick in. So for my condition they certainly helped my comfort level but were probably detrimental to the cause of the injury (assuming they masked the pain).

It is certainly best to find a way to get rid of the problem that creates the pain, but if this is not possible it would be interesting to know if there are any "safe" drugs that could be taken in small doses every day prior to a training run (such as a couple of ibuprofen or paracetamol or other).

Regards, Justin.

PhysioLarry, on Jan 29 2008, 12:22 AM, said:

Hi all,

Thought it would be interesting to see what CR's take by way of medication to help get through events. See JustinS007's regime for the marathon.

I recently had a patient say he used 2 nurofen tablets at 30km into the New York marathon with good effect, and I'm aware that many comrades runners take Besenol during the run.

Please detail dosages if your'e adding to the thread and hopefully we can get a sports doc to comment...

regards

Larry

[brizza]

hey guys,do i get the impression here that you are taking drugs to get through racing and training?

[Phoenix]

Tim 2, on Feb 1 2008, 09:14 PM, said:

these tablets greatly increase the chances of acute renal failure a very serious and potentially life threatening situation.

Thanks for this advice - brilliant post.

[Optimistic]

If you are "masking" your physical pain with drugs just to reach the next training goal. Isn't that the same as "masking" your social persona drinking alcohol/taking drugs recreationally.

[rodthehornet]

Optimistic, on Feb 5 2008, 11:28 PM, said:

If you are "masking" your physical pain with drugs just to reach the next training goal. Isn't that the same as "masking" your social persona drinking alcohol/taking drugs recreationally.

Actually completely different:

- I dont steal to support my Nurofen habit.
- I dont get the DT's in the morning when I wake up if I havent had my Nurofen.
- When I come down off Nurofen I dont get sweaty and irritable.
- I can walk past a chemist and not get the urge to go in and pop a Nurofen.
- I havent heard of Nurofen Anonymous meetings.

Your analogy is just a little out there. Drugs/alcohol cause all sorts of problems in society, as opposed to a couple of runners who enjoy going for a run and have a few niggles.

BTW, I am interested to hear what drugs can be used 'recreationally'. I take it you mean those 'party' drugs such as ice, cocaine and cannabis that dont really cause any long term problems.

Rod

[brizza]

nurofen can cause asthma,kidney damage,affects your clotting,it can burn a hole in your stomach,running is supposed to be good for your health,long term nurofen may cause scarring in your stomach and oesophagus from ulcers you didn't know you had-'nuff sed

[grimsey]

brizza, on Feb 7 2008, 07:12 AM, said:

nurofen can cause asthma,kidney damage,affects your clotting,it can burn a hole in your stomach,running is supposed to be good for your health,long term nurofen may cause scarring in your stomach and oesophagus from ulcers you didn't know you had-'nuff sed

i once tried some nodoz at 24 hr rogaine and they caused my heart rate to jump pretty high.ive never used any form of medication in any sort of run or event before, but as my companions on the rogaine where taking in caffeine and as ive never drank cofee in my life i thought nodoz would be the best way to go for me, but never again.

[undercover brother]

Optimistic, on Feb 5 2008, 10:28 PM, said:

If you are "masking" your physical pain with drugs just to reach the next training goal. Isn't that the same as "masking" your social persona drinking alcohol/taking drugs recreationally.

no

[Mick]

Hi,

Short Question: Is it a good idea to use voltaren gel on a sore achillies to aid recovery ?

More Information: Two weeks out from Hunter Valley marathon a 28km run left me with a sore achilles. I didn't want this to affect my marathon, so was keen to do anything to speed up recovery. A bit of searching on CR and I thought some voltaren gel on the area (as well as rest and ice) was a good idea. I used the gel for 2-3 days, the pain went, I figured I would give it the rest of the week to be sure. One week from HVM I did a 14km pacing run, and the pain was back. It wasn't bad, but I was worried about the marathon. More ice, rest, and gel, and fronted for the marathon. It was there in the marathon, but didn't slow me down, but when I cooled it was quite sore (iced it straight away). I figured three weeks in a row, this time I needed to let this heal. Only problem was City2Surf was coming up. I stopped running for the three weeks, and did more bike to try and keep my fitness. I used gel for the first few days, the pain was gone at about 10 days, so I figured being pain free for over a week I should be right for the City2Surf. I was also doing walks to warm up, stretches, heel drops too.

It came back in the City2Surf, not bad, much less than at the end of the marathon. The way its going I will be pain free in a few days.

I'm entered in the Max Adventure 24h, with partner, in about 6 weeks, so having more than 1-2 weeks off running wouldn't be ideal.

I _should_ know what I am using, but I thought the gel was only an anti-inflamitory, I didn't realise it was masking the pain (not that I trained while using it). I'm the sort of person who wouldn't normally take asprin for a head ache, but the months of training I'd put in the marathon made me weak. I'm probably also stupid for thinking that if you can buy something from the supermarket shelf then it wouldn't have any serious side affects if following the directions.

PS Didn't want to start a new voltarin thread, this was the best one I could find ...

PPS Today while blowing my nose I got a bleed. I had one a few weeks back also, which isn't a normal occurance. I didn't realise until searching CR that voltaren is quite possibly the cause of this.

[StellaBella]

I can't really help with your question as I have a similar one of my own... and figure I may as well ride on you thread coat tails.

How bad are NSAIDs... I mean how much is too much and how long is too long? Just curious here (talking bout oral eg. ibuprofen)...

[seris]

I work witha Cardiac surgeon who would never take ANY Nurofen in a marathon for fear of renal impairment and dialysis. Being dehydrated and taking NSAIDS is definitely not a good idea.

[markc]

seris, on Aug 12 2008, 07:44 PM, said:

I work witha Cardiac surgeon who would never take ANY Nurofen in a marathon for fear of renal impairment and dialysis. Being dehydrated and taking NSAIDS is definitely not a good idea.

I was told teh same thing by my doctor, I didn't even realise so I stopped taking them when running any distance. I believe my ability of my kidneys to rid myself of urine is quite good. I wouldn't want to lose the joy of that morning piss.

On a serious note.. any type of pain relief can mask anything else that may twinge.. I guess if it's bad enough to require pain relief when running, then you really need to look at trying to let the issue sort itself out and heal? Thats just my own personal opinion on it though. Others may be fine using it if they have a non-worsening injury as a comfort things.

Cool bananas.

M

[JustinS007]

StellaBella, on Aug 12 2008, 08:25 PM, said:

How bad are NSAIDs... I mean how much is too much and how long is too long? Just curious here (talking bout oral eg. ibuprofen)...

I ebb and flow on this topic like I change my socks. Not being a chemist or GP or Haemotologist it's hard to know for sure what's right and what's wrong. We can only go on what we're told.

Shaz went to see an 'out-of-town' highly credentially, ex-top runner physio about a hip problem that she's having. He was suprised that she wasn't taking anti-inflammatories daily with the amount of running she is doing. Like a therapeutic dose of 2 x 200mg tablets. He knows of many athletes (not just runners) that take NSAID's every day whether they have pain / inflammation or not. He suggests that 2 tablets a day won't hurt anyone.

So what is right and what's not? Maybe like anything a small amount is OK, but too much is a bad thing. Sure, there will always be the cases where even a small dose of something has a detrimental effect on some people, but for the average Joe are NSAID's all that bad in small, controlled doses?

I take ibuprofen when I need it. These days only 1 tablet at a time and then a 2nd one 1 hour later if I feel I need the extra boost. Probably amounts to 2 tablets a week on average. It also helps me sleep for some reason.

J.

[seris]

Tim 2, on Feb 1 2008, 09:14 PM, said:

I don't have any qualifications in sports medicine but am a doctor and a keen ultramarathoner.

I have always been concerned at the use of nurofen or other anti-inflammatories especially in long races/runs. In combination with dehydration (which is almost inevitable) these tablets greatly increase the chances of acute renal failure a very serious and potentially life threatening situation. Renal impairment is a known and common side effect of these drugs and i imagine a significant percentage of nurofen users who get dehydrated on a run will have a mild renal impairment which gets better when the rehydrate and stop taking the drugs. Acute renal failure is worst case scenario and is unlikely to happen to most of us but it will happen to someone in Australia one day (i've heard of it happening overseas). They will potentially need intensive care and dialysis at least for several days or weeks and potentially for the rest of their life. The risk is greatest in those with other kidney problems, which may not even be known to the person with them, and those with high blood pressure (especially those taking many of the common medications for this) or diabetes and older people (kidney function declines with age and you have less reserve). Asthmatics should be extra careful with anti-inflammatories because they can increase the likelihood of an asthma attack.

In short i don't do painkillers on a run because i believe the risks outweigh the potential benefits. My advice would be make sure you understand the risks before you take anything.

Hope that helps

Tim

"BUMP"
I don't understand why people are still happy to push the non steroidals (nurofen etc) when there is such a risk of long term renal failure. A doctor at work had early signs of renal failure after taking 2 nurofen and going for a bike ride. Just like smokers that end up with cancer, the info is out there..... don't take non steroidals with long runs when the risk of dehydration is possible. You don't know what it is doing to your kidneys in the long term.

[Colin]

seris, on Feb 5 2009, 12:20 PM, said:

I don't understand why people are still happy to push the non steroidals (nurofen etc) when there is such a risk of long term renal failure. A doctor at work had early signs of renal failure after taking 2 nurofen and going for a bike ride. .

Thanks for info.

Just curious what sort of renal failure signs he had, how it was measured, would he have had it without going for bike ride, how far he road, what effort, what did he do beforehand...i.e. was he dehydrated, hungover etc etc....so many variables that could affect one person.

....otherwise, because at that low dosage it appears that it is harmful to all people out there , whether riding, running or sitting on couch etc... yet the statistics don't support that.

cheers

[Mick]

Good discussion on the morals of taking them at transitions

http://forums.transitions.org.au/index.php...f=2&t=28388

IMHO Expected muscle pain is part of training / racing and I won't be popping a pill to make it go away.

[DrJH]

Its interesting that the doctors responding to this thread are the ones who avoid medication and the lay people are the ones trying a bit of anything.

I avoid medication where possible. I don't see much of a role for analgaesics and anti-inflammatories. Just because you can get this stuff over the counter doesn't mean there aren't potential side effects. If you've got that much pain you probably shouldn't be running. If you can't run without limping you shouldn't be running. Surely the pill-popping mentality is contrary to the healthy lifestyle we are trying to embrace as a part of running!

The chances are you can take most things and be okay. Why risk it though? Why go down that path anyway? Surely the thinking that allows the use of analgaesics/anti-inlfammatories is only a short step away from that that justifies steroids, EPO, etc.

Self medicating can be dangerous.

[blair]

I've never taken any medication to get through a training run or a race. However, recently, I injured my knee falling from my bike and didn't find out about it until halfway through an ultra a few days later.

I struggled through without any drugs but, afterwards, my massage therapist told me I should have taken some anti-inflammatories. I questioned her about the wisdom of masking the pain but she said that the anti-inflammatories would actually help the knee to heal faster so they were not just a pain suppressant.

I know she is just a massage therapist and probably not qualified to comment and I still haven't used any drugs to get through training or races since but I did take some Nurofen after that whenever I had pain in the knee just walking around etc. But I would like to hear opinions on whether she's right or not, especially from Tim 2, UCB or Dr JH.

Thanks

[Colin]

mmmm..


Many people usually leave the doctor's surgery with a script for some medicine, after not very extensive investigation either (more like "are you allergic to this or that").
This is how the drug companies make their money...they sell to doctors not to the patient.

Most people would prefer not to take medicine.

btw the medical opinion of NSAIDS has fluctuated back and forth over the years...almost becoming like economists now

[Leofisio]

balri, on Feb 6 2009, 12:23 PM, said:

I But I would like to hear opinions on whether she's right or not, especially from Tim 2, UCB or Dr JH.

Thanks

Hi Balri,

Although I have limited knowledge with medication (I am a Physio) I have to say that your massage therapist is absolutely wrong... my impression given the information that she provided to you is that she does not understand what NSAIDs do, and also does not know the risks/benefits of its use.

I am happy that you are not taking anything, and medication-related advice should be given by a medical doctor.

Cheers,

Leo

[tank girl]

I'm very anti-medication myself. (That said, I'm generally anti-doctor, too, and try to avoid them unless it's in the emergency room.) I took some ibuprofen at the 90 mile mark in Western States when my left tibialis anterior started spasming very painfully. I had been running well for the previous 20 miles so I was confident I was in a pretty good state. I had no other cramping. Therefore, I took one pill (low dose works because I so rarely take them).

However, if it had happened at mile 20, I probably would have just quit the run. I'm not an elite athlete, and I wouldn't want to risk doing more damage that puts me out of running for years. I admire runners who finish a race despite injury, but I'm just not stupid enough to try it myself. If I was an elite athlete at the worlds or something, I'd probably just take the drugs and go for it.

I am more likely to use anti-inflammatories when I am not running (and not stressing my body), to get my body back to a state where I can re-train the muscles properly and then return to running without re-injuring. I had a knee injury a while back, and I couldn't do any postural/running drills properly because of the discomfort. Two weeks of low-dose NSAIDs sorted me out; re-training prevented it from happening again.

[glenda]

confession,Yesterday I took my first anti inflammatory drug. After some persistent knee pain an MRI showed significant inflammation, bursistis, in a part of the knee which name I can't recall. But my knee is noticeably swollen even to the layperson. I was advised to take them to reduce the inflammation, makes sense to me.

[Bellthorpe]

seris, on Feb 5 2009, 11:20 AM, said:

A doctor at work had early signs of renal failure after taking 2 nurofen and going for a bike ride.

Hmmm ...

[Kandingo]

a guy died on a bicycle ride after taking only 1 nurofen tablet !!

not sure if the tow truck that hit him head on contributed to his demise ...

[JustinS007]

Kandingo, on Feb 6 2009, 05:31 PM, said:

not sure if the tow truck that hit him head on contributed to his demise ...

I doubt it. Definately sounds like the ibuprofen to me.

In all seriousness though I think it's time for a bit less "I've heard that", "innuendo", "speculation" and so-forth and look at the facts. Yes, facts can also be manipulated, but when the likelihood of getting renal failure from the odd ibuprofen pill outweighs the likelihood of getting hit by a bus then I'll consider stopping taking them. I've not seen ANY evidence that suggests that a fit healthy person taking a couple of pills when they feel they needs them is a problem. Fit healthy people with UNDIAGNOSED renal / kidney issues is another story, but then they weren't fit healthy people were they.

Here's a good PP presentation (not sure how to paste the link so the below may not make sense):
Ibuprofen and Renal Failure
Professor Nicholas Moore
International Ibuprofen Foundation
University of Bordeaux, France
Background
Renal prostaglandins essential for GFR
Especially in elderly, children, heart failure
Known for all NSAIDs
Some case reports with ibuprofen
Risk of widespread OTC use?
In adults
Better tolerated than aspirin
Tolerance equivalent to paracetamol
Including GI and renal events
In clinical RCT of 8644 adults, used for OTC indications
Renal Failure in the Elderly
In Children
Randomized DB clinical trial
Paracetamol vs ibu 10, 15 mg/kg
Hospital admissions
84 000 children incl 27 000 < 2 yrs old
Not a single case of renal failure
upper bound CI < 5.4/100 000
No difference in admission creatinine
In Newborns
As effective as indomethacin to close patent ductus arteriosus
Without renal toxicity
In Overdose
No need to monitor if less than 6 g (30 tabs)
Reversible renal failure in severe overdose

And this (if you have undiagnosed kidney issues then it could be a worry):
http://query.nytimes.com/gst/fullpage.html...757C0A966958260
Stating:

Quote

The popular pain reliever ibuprofen can cause kidney failure in people with mild kidney disease, according to a new study.
The study examined the short-term effects of ibuprofen on 12 women with mild kidney disease who also had arthritis and high blood pressure, two illnesses that often prompt its use.
.....gave participants above-normal doses of 800 milligrams of ibuprofen three times a day - the equivalent of 12 ibuprofen tablets - for up to 11 days.
After eight days, three women developed kidney failure, which reversed when ibuprofen was discontinued. The remaining nine women, who received ibuprofen for 11 days, showed changes in kidney function but did not develop kidney failure.
''Patients with previously undiagnosed mild renal impairment may consume therapeutic doses of ibuprofen without supervision'' and could suffer severe kidney damage, they wrote.

And this one:
http://www.fda.gov/ohrms/dockets/ac/02/bri...0Foundation.htm
Stating (in part):

Quote

6. Renal effects

Renal adverse events associated with NSAIDs are uncommon at prescribed doses but may be severe. Short half-life NSAIDs such as ibuprofen are associated with a lower risk of renal effects than NSAIDs with a longer half-life (Stürmer et al, 2001). Short-term use of ibuprofen does not significantly increase the risk of renal impairment in healthy volunteers (Murray and Brater, 1999; Svendsen et al, 2000) or in children with febrile illness (Lesko and Mitchell, 1997; Lesko and Mitchell, 1999). Long-term treatment with ibuprofen at a dose of 1200 mg/day does not increase the risk of renal impairment in elderly people (Griffin et al, 2000). Ibuprofen is associated with a low risk of renal toxicity in overdose (Jenkinson et al, 1988; Volans and Fitzpatrick, 1999).

A long post, but one at least which provides some evidence (or lack of) problems associated with healthy adults taking small amount of the drug infrequently.

As to the argument about it being likened to cheating because it masks pain and we should just toughen up, well, personally I think that's a load of rot. And taking them giving an unfair advantage? Crikey, give me a break. What's next, we ban water because it helps to stimulate the elasticity of muscles and increases the uptake of carbohydrate that we consume? Yeah, sounds unfair to me.

J.

[JustinS007]

JustinS007, on Feb 6 2009, 08:11 PM, said:

A long post, but one at least which provides some evidence (or lack of) problems associated with healthy adults taking small amount of the drug infrequently.

Found one! Although I'm not sure that up to 2400mg daily (12 tablets) is a small amount infrequently. And he was complicating the issue with other products as well. Also, the summary again cites 'susceptible patients':

http://jasn.asnjourn...print/5/12/2020

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A 37-yr-old black man developed nonoliguric acute
renal failure (ARF) alter strenuous exercise. He had
excellent health except for 12 yr of mild essential
hypertension and osteoarthritis of the knees. Medications
included 800 mg of ibuprofen one to three times
daily as needed for knee pain and one combined
hydrochlorothiazide (50 mg) and triamterene (75 mg)
pill each day. In the past 4 yr. blood pressure (BP)
ranged from 124/80 to 140/90 mm Hg.

[undercover brother]

balri, on Feb 6 2009, 11:23 AM, said:

...I struggled through without any drugs but, afterwards, my massage therapist told me I should have taken some anti-inflammatories. I questioned her about the wisdom of masking the pain but she said that the anti-inflammatories would actually help the knee to heal faster so they were not just a pain suppressant.

I know she is just a massage therapist and probably not qualified to comment and I still haven't used any drugs to get through training or races since but I did take some Nurofen after that whenever I had pain in the knee just walking around etc. But I would like to hear opinions on whether she's right or not, especially from Tim 2, UCB or Dr JH.

i am not so concerned about masking the pain as such.
sure the anti-inflams will reduce inflammation but so will not running the last 30km on a buggered knee.
it is non-sensical to suggest both.
unless you are trying to win the aussie mtb champs which is where she is obviously coming from.

i would prefer to either stop/pull out, rest, rehydrate then take a brief course of nsaids at home.
or take nothing, push on and bugger it good and proper.
...well for me usually the latter.
running ultras and taking nsaids simply dont mix.
end of story.

[LaDiDa]

Surely there is no wrong or right answer?

I am a long term user of NSAIDs as well as a whole raft of other pain medication. I am under the care of a pain management specialist but this is the only way I can live anything resembling a normal life. I have discussed with him some of the issues raised in this thread but I don't think I will ever be in a position to run a marathon or finish ironman. Its a balance of risk an benefit and its a risk I am willing to take but I also think that given my chronic pain syndrome the benefit is also greater.

If you niggling ongoing injuries then NSAIDS are just one part of the risk/benefit analysis of running...when maybe you just shouldn't.

[Mick]

LaDiDa, on Feb 8 2009, 11:38 AM, said:

Surely there is no wrong or right answer?

If you are taking them under the direction of a doctor then this is something completely different ...

My comments were directed when doing marathon+ events, no injury, things start getting a bit tough, so pop a pill. I think it was on transitions that I read about people "predicting pain" and taking them in advance and then on a schedule. Not against any rules, so I'm not saying its wrong, ignoring any health risks, it would leave a doubt in my mind about how I would have finished without taking the pill.

[LaurenR]

I am interested to know if there are any rules or regulations in Australia in regards to taking medications during races? If so, where do they draw the line? If ibuprofen and other NSAID's help mask pain and reduce inflammation then isn't that a performance enhancing drug? (Because presumably you'd perform a bit better due to less pain than if you didn't take it)?

So - does that mean it's unfair for those who choose not to take any medications?

I'm a nurse and by nature err on the side of caution - at the end of the day people have all the information available (or should seek it out from their Doctor or pharmacist) so it's up to them what they choose to do with it.

Having said that, I suffer from migraines and when one hits I would swallow any analgesics in reach... pain makes people do crazy things.

Edited by LaurenR, 11 February 2009 - 02:25 PM.

[TechGirl]

LaurenR, on Feb 11 2009, 02:22 PM, said:

If ibuprofen and other NSAID's help mask pain and reduce inflammation then isn't that a performance enhancing drug? (Because presumably you'd perform a bit better due to less pain than if you didn't take it)?

So - does that mean it's unfair for those who choose not to take any medications?

These kinds of drugs aren't really "performance enhancing", one could argue that they are performance restoring. They don't make you perform better but rather attempt to "normalise" performance. The ones that enhance performance are the likes of anabolic steroids, growth hormones, stimulants, etc.

There are many elite athletes that have asthma and rely on their inhaled products to be able to compete, your argument above would exclude asthmatics from being able to compete. These people aren't going to suddenly be markedly better than the general population due to taking their medications, it instead allows them to be able to compete on an equal playing field. As good as NSAIDS are for mild pain, they really don't do a brilliant job of completely masking pain. Hence, corticosteroids and other more potent analgesics are on the banned list (unless you are in professional football or such ).

One could easily diverge into the debate of drug use in performance horses, but lets not open that can of worms.

TechGirl

[LaurenR]

TechGirl, on Feb 11 2009, 01:42 PM, said:

They don't make you perform better but rather attempt to "normalise" performance.

TechGirl

Very good point

[yeti]

DrJH, on Feb 5 2009, 10:53 AM, said:

Its interesting that the doctors responding to this thread are the ones who avoid medication and the lay people are the ones trying a bit of anything.

So just to add some balance: I'm not a (medical) doctor, and I'm not taking medication to help me run.
From my view there are two arguments against it:
The first issue is the potential for medical problems, i.e. side effects of the medication but probably more importantly the risk that the medication (painkillers) is just masking the symtoms and to continue running will aggravate the underlying problem.
The second (IMHO more important) issue is ethical: where do you draw the line between "self-medication" and "doping"? You can of course take the lawyer's view that as long as its not on the prohibited list its not doping so you can take it, but, not being a lawyer, I don't quite subscribe to that view.

DrJH, on Feb 5 2009, 10:53 AM, said:

Why go down that path anyway? Surely the thinking that allows the use of analgaesics/anti-inlfammatories is only a short step away from that that justifies steroids, EPO, etc.

Fully agreed.

And btw, the argument that taking painkillers, anti-inflammatories and such stuff is merely "normalizing" your performance i.e. bringing it back to its "normal" level doesn't cut it. If, for example, people abuse painkillers to sustain a higher training volume than they otherwise could, is that "normalizing" ???

Yeti

[undercover brother]

yeti, on Feb 11 2009, 08:45 PM, said:

So just to add some balance: I'm not a (medical) doctor, and I'm not taking medication to help me run.
From my view there are two arguments against it:
The first issue is the potential for medical problems, i.e. side effects of the medication but probably more importantly the risk that the medication (painkillers) is just masking the symtoms and to continue running will aggravate the underlying problem.
naahhhhhh i'm not so concerned about the masking mainly the potential side-effects particularly in the longer events: renal/kidney failure and low sodium/hyponatraemia.
The second (IMHO more important) issue is ethical: where do you draw the line between "self-medication" and "doping"? You can of course take the lawyer's view that as long as its not on the prohibited list its not doping so you can take it, but, not being a lawyer, I don't quite subscribe to that view.
ethical smethical i just dont want to end up on dialysis

[JustinS007]

yeti, on Feb 11 2009, 09:45 PM, said:

And btw, the argument that taking painkillers, anti-inflammatories and such stuff is merely "normalizing" your performance i.e. bringing it back to its "normal" level doesn't cut it. If, for example, people abuse painkillers to sustain a higher training volume than they otherwise could, is that "normalizing" ???

Define "abuse".

Oh, and can I have a coffee before a morning run? It definately makes me run better, but caffeine is a drug.

J.

[TechGirl]

IMHO you are giving the "legal" NSAIDS far more credit than they deserve. They really aren't great analgesics and would struggle to fully mask a serious condition. What UCB says is correct, their side effects are what are far more concerning.

Yes there are stronger products out there that can overly mask signs, but they are prescription only and so not as open to abuse. Plus many are on the banned list.

The odds that you can continue to do massive training using "legal" NSAIDS is not highly likely in the grand scheme of things.

Cheers,

TechGirl