Painkillers–Running the Risks

Nobody ever said running a marathon was easy or comfortable.  Getting to the start line uninjured is a task all by itself, and completing the marathon can be arduous and painful.  Many people would like to make it less uncomfortable by taking some pain relievers right before the race starts and hope that these medications will ease the pain during their path to the finish line.  According to a new study, this would be ill-advised.

  Here’s the quick summary – researchers did a survey of 7,048 marathon runners in the 2010 Bonn Marathon.  4,000 of them returned their questionnaires.  Of those 4,000 runners, 61% of women and 42% of men took painkillers (analgesics) before the race.  93% of them said they were never told about the risks associated with taking these meds in connection with endurance sports (hence, the reason why I chose this topic for the newsletter).

  OK, the results…

  The analgesic group overall had 5 times the adverse effects compared to the non-analgesic group.  These included gastrointestinal cramping and bleeding, blood in the urine and cardiovascular events (both heart attacks and palpitations)

adverse events from NSAIDS in marathon

  When we take that data and screen out the less to moderate adverse events, we are left with those who suffered more serious health problems – those that required hospitalization within 3 days following the marathon.  Overall, there were 9 marathoners that required hospitalization – all of them were in the analgesic taking group.  Of those 9, three were because of renal problems (too much urinating, no urinating or blood in the urine) and all three of those had taken ibuprofen.  Four of the nine in the hospital were because of gastrointestinal bleeding (all four had taken aspirin).  The other two of the 9 in the hospital had suffered heart attacks (both recovered) and both had taken aspirin before the race (one took 100mg, the other took 500 mg)

In an ironic twist, those that took analgesics were more likely to have aches and pains after the race.pain after NSAIDS in marathon


  All of the adverse events were dose dependent.  In other words, the more meds you take, the higher the risk of bad stuff happening to you.  Not surprising.  What is surprising to me is that 93% of the respondents report that they were unaware of the risks involved.  This was all reported in an earlier study (Gorski et al., 2010) in the 2008 Ironman Brazil were they found “high prevalence of NSAID consumption, limited awareness of the effects and side effects of them and a high rate of nonprescribed use.”

Moreover, this current study found that most of the runners taking analgesics took them at “supratherapeutic doses”.  In other words, more than what is recommended. 

  Unfortunately, many endurance athletes think that these meds will decrease pain and increase performance.  This study found that there was in fact more pain reported in those taking analgesics, however, this could be explained in a number of ways.  For example, of those taking the meds, 11% said they had pain before the race started, compared to 1% who didn’t take the meds.  In other words, they may already have had some sort of injury.  Also, these analgesics tend to have a half life of about 2 hours, so it is possible that those taking the meds took them at or near the beginning of the race, but stopped taking them in the latter half of the race.  This trend was reported by Nieman et al 2006, when surveying runners in an ultramarathon in 2006.

  That same researcher (Nieman) wrote an article in Marathon and Beyond where he talked about his previous research papers and stated, “We were unable to measure any benefit of using ibuprofen by WSER [Western States Endurance Run] athletes, only harm…Every indication from our research showed that ibuprofen amplified inflammation and oxidative stress while providing no relief from exercise effort or muscle damage and soreness.”  I would highly recommend you read that article in Marathon and Beyond, as there are plant based anti-inflammatory alternatives recommended by that same researcher.

  So there you have it.  There is growing evidence that taking these meds before and during endurance events is a risky, ill-advised choice.  I won’t pretend that I haven’t done it before during any marathons or Ironmans that I’ve done.  It’s not that I was unaware of the side-effects, I just didn’t realize the risks were that high.  Better to be safe than sorry.  Besides, who said you shouldn’t feel a bit of pain during a marathon?  Was it supposed to be easy?