Nonsteroidal Anti-inflammatory Drug Use in Collegiate Football Players
Holmes N, Cronholm PF, Duffy AJ, Webner D. Clin J Sport Med. 2013. Epub ahead of print
Take Home Message: NSAIDs are a common treatment method for musculoskeletal injuries; however, over-the-counter availability, overuse, self-medication, and trends of initial use in high school may interfere with appropriate consumption among college athletes.
Nonsteroidal anti-inflammatory drugs (NSAIDs), a common treatment for athletic injuries, are generally safe medications when used short-term but can become problematic when used long-term and without oversight from a medical professional. There is a discrepancy between the amount of NSAIDs used in athletics and the number of studies that address their safety in athletics. In this cross-sectional study, Holmes et al. surveyed 211 collegiate football players at two institutions on two occasions (beginning of 2006 and 2009 seasons) regarding their NSAID use during the respective seasons. The authors categorized athletes as “high users” (NSAID use daily or weekly) and “low users” (NSAID use monthly or rarely). The authors then compared off-season use and in-season use of NSAIDs between high- and low-use groups. Half of all athletes reported high use of NSAIDs in-season compared to only 15% during the off-season. During the season, 33% of high users consumed NSAIDs after games, 11% before games, and < 1% during games. For the same group, after-practice use of NSAIDs was the highest (20%), followed by before-practice use (5%), and during-practice use (< 1%). Close to half of all athletes first utilized NSAIDs in high school (49%), followed by junior high (46%), and only 6% reported first use of NSAIDs in college; which they received from a variety of sources: themselves, parents, athletic trainers, and physicians. NSAIDs were largely obtained over the counter (81%); in comparison, only 27% obtained from physicians and 30% from athletic trainers. Approximately, 57% of athletes with a higher body mass index (> 28.2 kg/m2) utilize NSAIDs in-season compared with 40% of athletes with lower body mass index (< 26.6 kg/m2). Finally, only 3% of athletes reported adverse reactions to NSAIDs.
This study demonstrates overuse and potential for misuse of NSAIDs in a college football population. More research is needed to generalize these results, but they raise concern for athletes’ health. This study also touched on health concerns by reporting adverse reactions; but the number of adverse reactions could have been higher since they can often be asymptomatic and require lab work to fully evaluate them. This issue is further complicated by athletes self-medicating with NSAIDs, which leaves the medical staff unaware of frequency and dosages. Medication management for college athletes is difficult because of the various sources and the ease with which NSAIDs can be obtained. Athlete education focused on adverse reactions and their warning signs may help to solve over-medicating. In addition, it might help to cut down on confusion in self administration of medications, as previously reported by Wolf et al. Furthermore, improved supervision of over-the-counter medications should be addressed to aid the medical staff in managing athlete consumption.
How can the sports medicine community work together to improve medication safety for athletes? What interventions could help to decrease the first time use of NSAIDs in high school athletes?
Written by: Christian Glaser, DO
Reviewed by: Laura McDonald