NSAID Useage

This was previously a page on our website but we feel this is a more appropriate place to share.

I’ve been following several threads in an Ultra-marathon Medical Director’s email group and felt it was prudent to create a page here to post the summaries of the various discussions. I know as ultra-runners we’re a wildly independent bunch and don’t respond well to mandates from “think-tanks”, but I’m keeping this page tuned to information generated from physicians and others who are in the middle of the ultra-running world and trying to keep us all aware of the most recent medical findings surrounding our sport.

One recent thread regarding NSAID use can be summarized in the following bullets:

  • The theoretical risks from NSAID use in this environment are clear, and so NSAIDs should not be made available by the race. 
  • Regardless of the grouping, if a drug inhibits prostaglandin it would be just as dangerous to kidney function.
  • Runner education about the concerns of NSAID use should continue. This should not be limited to education about use during a race, but also should include education about the risks from chronic use during times of injury.
  • Runners can easily carry their own drugs if they continue to desire to use them.  
  • Most race’s medical directors in the thread don’t believe there is any solid evidence that NSAIDs actually reduce pain. One of the physicians in the thread was only aware of one paper that looked at this (from a study at WSER), and they found no benefit in terms of pain relief of reduced delayed-onset muscle soreness.  
  • In a recent study (the paper is currently in review, and is expected to be presented at ACSM in 2012) at the 2011 WSER, post-race blood work was done on approximately half the finishers. Based on “injury” and “risk” criteria for acute kidney injury of blood creatinine 2.0 and 1.5 times estimated baseline, respectively, 4% met the criteria for injury and an additional 29-30% met the criteria for risk of injury. There was no statistical difference in the use of NSAIDs among the three groups (those with injury, those at risk, and those not meeting either criteria). The posting physician suspects that this finding just points out that factors in addition to NSAID use are often more important in the potential development of renal injury in ultra-marathon running – the so called “perfect storm.” The overall NSAID use was 34%. Interestingly, the use of NSAIDs was at 57% in 2009, so hopefully this represents some progress with educational efforts.
  • It was generally agreed that limited use (a few hundred milligrams per 24 hr period) of NSAIDs or Tylenol was not likely to cause health effects, but other factors endemic to ultra-running combined with increased use of either of these could compound to create health effects.
  • There is a small trend being discovered by some race medical directors indicating that narcotic use during events may also be occurring, which is completely contra-indicated and dangerous.