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Solano-Orrala D, Silva-Cullishpuma DA, Díaz-Cruces E, Gómez-López VM, Toro-Mendoza J, Gomez d'Ayala G, Troconis J, Narváez-Muñoz C, Alexis F, Mercader-Ros MT, Lucas-Abellán C, Zamora-Ledezma C. Exploring the Potential of Nonpsychoactive Cannabinoids in the Development of Materials for Biomedical and Sports Applications. ACS APPLIED BIO MATERIALS 2024; 7:8177-8202. [PMID: 39563525 DOI: 10.1021/acsabm.4c01402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2024]
Abstract
This Perspective explores the potential of nonpsychoactive cannabinoids (NPCs) such as CBD, CBG, CBC, and CBN in developing innovative biomaterials for biomedical and sports applications. It examines their physicochemical properties, anti-inflammatory, analgesic, and neuroprotective effects, and their integration into various biomaterials such as hydrogels, sponges, films, and scaffolds. It also discusses the current challenges in standardizing formulations, understanding long-term effects, and understanding their intrinsical regulatory landscapes. Further, it discusses the promising applications of NPC-loaded materials in bone regeneration, wound management, and drug delivery systems, emphasizing their improved biocompatibility, mechanical properties, and therapeutic efficacy demonstrated in vitro and in vivo. The review also addresses innovative approaches to enhance NPC delivery including the use of computational tools and explores their potential in both biomedical and sports science contexts. By providing a comprehensive overview of the current state of research, this review aims to outline future directions, emphasizing the potential of NPCs in biomaterial science and regenerative medicine.
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Affiliation(s)
- Dulexy Solano-Orrala
- Higher Polytechnic School, UAX-Universidad Alfonso X el Sabio, Avda. Universidad, 1, Villanueva de la Canada, 28691 Madrid, Spain
| | - Dennis A Silva-Cullishpuma
- Nutrition, Food and Health (NAS), Faculty of Pharmacy and Nutrition, UCAM-Universidad Católica de Murcia, Avda, Los Jerónimos 135, Guadalupe de Maciascoque, 30107 Murcia, Spain
| | - Eliana Díaz-Cruces
- Law Ecotechnology and Innovation Keys for the 21 st Century Development Research Group, Faculty of Law, UCAM-Universidad Católica San Antonio de Murcia, Campus de los Jerónimos 135, Guadalupe, 30107 Murcia, Spain
| | - Vicente M Gómez-López
- Green and Innovative Technologies for Food, Environment and Bioengineering Research Group (FEnBeT), Faculty of Pharmacy and Nutrition, UCAM-Universidad Católica de Murcia, Avda, Los Jerónimos 135, Guadalupe de Maciascoque, 30107 Murcia, Spain
| | - Jhoan Toro-Mendoza
- Centro de Biomedicina Molecular, Instituto Venezolano de Investigaciones Cientificas, Maracaibo 1020A, Venezuela
| | - Giovanna Gomez d'Ayala
- Institute of Polymers, Composites and Biomaterials (IPCB), National Research Council, Via Campi Flegrei, 34, Pozzuoli, 80078 Naples, Italy
| | - Jorge Troconis
- Instituto Politécnico Nacional, ESIME-UPALM, Ciudad de Mexico 07738, México
| | - Christian Narváez-Muñoz
- Departamento de Ciencias de la Energía y Mecánica, Universidad de las Fuerzas Armadas (ESPE), Sangolqui 171103, Ecuador
| | - Frank Alexis
- Departamento de Ingeniería Química, Colegio de Ciencias e Ingenierías, Institute for Energy and Materials, Universidad San Francisco de Quito USFQ, Quito 170901, Ecuador
| | - Maria Teresa Mercader-Ros
- Nutrition, Food and Health (NAS), Faculty of Pharmacy and Nutrition, UCAM-Universidad Católica de Murcia, Avda, Los Jerónimos 135, Guadalupe de Maciascoque, 30107 Murcia, Spain
| | - Carmen Lucas-Abellán
- Nutrition, Food and Health (NAS), Faculty of Pharmacy and Nutrition, UCAM-Universidad Católica de Murcia, Avda, Los Jerónimos 135, Guadalupe de Maciascoque, 30107 Murcia, Spain
| | - Camilo Zamora-Ledezma
- Higher Polytechnic School, UAX-Universidad Alfonso X el Sabio, Avda. Universidad, 1, Villanueva de la Canada, 28691 Madrid, Spain
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Kopf A, Krutsch W, Szymski D, Weber J, Alt V, Bail HJ, Engel N, Rüther J, Huber L. Investigating Painkiller Use in Amateur Football: A Coach's Perspective. J Pers Med 2024; 14:1003. [PMID: 39338257 PMCID: PMC11432916 DOI: 10.3390/jpm14091003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/06/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Painkiller use in amateur sports and, especially, in football is increasingly being discussed, but the scientific data on this field are very limited. Therefore, the aim of this study was to investigate the prevalence of painkiller use in amateur football from the perspective of coaches, as well as to determine how and to which extent coaches can influence their teams in terms of painkiller use and prevention. METHODS Using an online questionnaire, a cross-sectional analysis of painkiller use in German amateur football from the 4th league to the lowest amateur classes was carried out from the perspective of team coaches. A total of 628 participants were contacted, and 400 (63.7%) completed the questionnaire completely and were therefore included in the evaluation. RESULTS Of the 400 participating team coaches in amateur football, 369 (92.3%) were male and 31 (7.7%) were female. The coaches reported that 36.2% (SD = 29.1) of their players have used painkillers at some point due to football-related pain in their career. The majority of coaches believed that the use of painkillers is not compatible with competition (74%), and even more believed that it is not compatible with football training (90.8%). Furthermore, 56.2% of the coaches themselves had already taken painkillers in their own football career for football-related pain, and 64% had already bought over-the-counter painkillers without a prescription. The use of painkillers increased in the higher playing levels. The availability of painkillers in first aid kits was reported by around 60%, but they were reported as freely accessible in the dressing room by only 10% of the coaches. CONCLUSIONS This is the first study to describe the painkiller use in amateur football from the perspective of coaches. The prevalence of painkiller use in this study was found to be significantly lower than what is indicated in the data from the existing literature. The majority of coaches see the use of painkillers during games and training as incompatible, even though there is a large proportion of coaches who have already bought over-the-counter painkillers for football-related pain. As the first scientific analysis of team coaches, this study provides fundamental data for the prevention of excessive painkiller use in amateur football.
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Affiliation(s)
- Andreas Kopf
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany; (A.K.); (N.E.)
| | - Werner Krutsch
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
- FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
- SportDocsFranken, 90473 Nuernberg, Germany
| | - Dominik Szymski
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
- FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Johannes Weber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
- FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
- FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
| | - Hermann Josef Bail
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany; (A.K.); (N.E.)
| | - Niklas Engel
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany; (A.K.); (N.E.)
| | - Johannes Rüther
- Department of Orthopaedics and Traumatology, Paracelsus Medical University, Breslauer Straße 201, 90471 Nuremberg, Germany; (A.K.); (N.E.)
| | - Lorenz Huber
- Department of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss Allee 11, 93053 Regensburg, Germany
- FIFA Medical Centre of Excellence, University Medical Centre Regensburg, 93053 Regensburg, Germany
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Rosenbloom C, Okholm Kryger K, Carmody S, Broman D. Non-steroidal anti-inflammatory drugs in football - a "Keeping SCORE" approach to judicious use. SCI MED FOOTBALL 2024; 8:1-5. [PMID: 36271815 DOI: 10.1080/24733938.2022.2140189] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 10/31/2022]
Abstract
Non-steroidal anti-inflammatory drug (NSAID) use in elite sport is high, with football being no exception. Increased awareness of significant adverse drug reactions from published research and retired players commentary in the media have made the topic mainstream. Despite this increased awareness, usage rates show no sign of significantly reducing. Footballers, like all elite athletes are focused on maximising their performance and potential - even at the expense of their long-term health. An educational intervention prior to the 2010 FIFA Men's World Cup aimed at reducing rates was ineffective, suggesting that education alone is not the answer. Our author group propose a 'safer use' rather than 'no use' of NSAIDs in football. A 'Keeping SCORE' approach is suggested, designed as a prescribing aid. The approach guides medical staff towards focusing on Safety checks, Clinical indication/judgement, Open dialogue, Recording, and Evaluation.
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Affiliation(s)
- Craig Rosenbloom
- Sport and Exercise Medicine Department, Queen Mary University of London, London, UK
- Medical Department, Tottenham Hotspur Football Club, London, UK
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
| | - Katrine Okholm Kryger
- Sport and Exercise Medicine Department, Queen Mary University of London, London, UK
- Faculty of Sport, Health and Applied Science, St Mary's University Twickenham, Twickenham, UK
| | - Sean Carmody
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Daniel Broman
- The Football Association, Technical Directorate, Burton-upon-Trent, UK
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Gjelstad A, Herlofsen TM, Bjerke AL, Lauritzen F, Björnsdottir I. Use of pharmaceuticals amongst athletes tested by Anti-Doping Norway in a five-year period. Front Sports Act Living 2023; 5:1260806. [PMID: 37860156 PMCID: PMC10582642 DOI: 10.3389/fspor.2023.1260806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction The aim of the study was to map the use of pharmaceuticals by Norwegian athletes registered on doping control forms (DCFs) in a five-year period to examine general and some class specific use of pharmaceuticals across sports and athlete levels. Method Anonymous data from DCFs collected in 2015-2019 were manually entered into a database using the Anatomical Therapeutic Chemical (ATC) system for classification of the pharmaceuticals. Variables entered were year of control, gender, age group, athlete level, sport, test type, nationality, and pharmaceuticals (and dietary supplements) used. Results Pain killers in the ATC groups M01 A (Nonsteroidal anti-inflammatory drugs - NSAIDs) and N02 B (other analgesics), and anti-asthmatics in ATC groups R03 A and R03 B were the most frequently used pharmaceuticals. National level athletes reported more use of pharmaceuticals (1.4 ± 1.7 pharmaceuticals per form) than recreational level athletes (0.9 ± 1.2). The highest proportion of DCFs containing information about at least one pharmaceutical were found in speed skating (79.1%), alpine skiing (74.0%), rowing (72.4%) and cross-country skiing (71.7%). Painkillers were most frequently used in muscular endurance sports (30.4% and 21.2 % for M01A and N02 B, respectively) and ball and team sports (17.9% and 17.0%). Use of hypnotics was reported from ice-hockey players and alpine skiers in around 8% of the cases. Coclusion Use of anti-asthmatics was most often reported amongst athletes specially exposed to cold, chemicals and heavy endurance training. Athletes in specialized sports requiring high levels of strength and/or endurance reported a higher use of pharmaceuticals out-of-competition compared to in-competition, while there was no such difference in complex sports, such as team, gymnastic, aiming and combat sports.
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Affiliation(s)
- Astrid Gjelstad
- Science and Medicine, Anti-Doping Norway, Oslo, Norway
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Tine Marie Herlofsen
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | - Anne-Linn Bjerke
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
| | | | - Ingunn Björnsdottir
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, University of Oslo, Oslo, Norway
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Leyk D, Rüther T, Hartmann N, Vits E, Staudt M, Hoffmann MA. Analgesic Use in Sports. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:155-161. [PMID: 36655316 PMCID: PMC10201949 DOI: 10.3238/arztebl.m2023.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 04/25/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND Consumption of medication to alleviate pain is widespread in Germany. Around 1.9 million men and women take analgesics every day; some 1.6 million persons are addicted to painkillers. Analgesic use is thought also to be common in sports, even in the absence of pain. The aim of this study was to assess the extent of painkiller use among athletes. METHODS In line with the PRISMA criteria and the modified PICO(S) criteria, a systematic literature review was registered (Openscienceframework, https://doi. org/10.17605/OSF.IO/VQ94D) and carried out in PubMed and SURF. The publications identified (25 survey studies, 12 analyses of doping control forms, 18 reviews) were evaluated in standardized manner using the Newcastle Ottawa Scale (NOS) and AMSTAR (A MeaSurement Tool to Assess systematic Reviews). RESULTS Analgesic use is widespread in elite sports. The prevalence varies between 2.8% (professional tennis) and 54.2% (professional soccer). Pain medication is also taken prophylactically in the absence of symptoms in some non-elite competitive sports. In the heterogeneous field of amateur sports the data are sparse and there is no reliable evidence of wide-reaching consumption of painkillers. Among endurance athletes, 2.1% of over 50 000 persons stated that they used analgesics at least once each month in connection with sports. CONCLUSION Analgesic use has become a problem in many areas of professional/ competitive sports, while the consumption of pain medication apparently remains rare in amateur sports. In view of the increasing harmful use of or even addiction to painkillers in society as a whole, there is a need for better education and, above all, restrictions on advertising.
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Affiliation(s)
- Dieter Leyk
- German Sport University Cologne, Research Group Epidemiology of Performance, Cologne; University of Koblenz; Bundeswehr Institute for Preventive Medicine, Division A Applied Health Promotion, Andernach; Bundeswehrzentralkrankenhaus Koblenz, Department of Anesthesiology and Intensive Care, Koblenz; University Medical Center of the Johannes Gutenberg University Mainz
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Mkumbuzi NS, Dlamini SB, Chibhabha F, Govere FM. Injury, illness, and medication use surveillance during the 2020 COSAFA Women's championship: a prospective cohort study of football players from Southern Africa. SCI MED FOOTBALL 2023; 7:74-80. [PMID: 36815605 DOI: 10.1080/24733938.2021.1971745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systematic analyses of injuries, illnesses or medication use and their risk factors among female African athletes are scarce, which has implications for management of these athletes. AIM This prospective cohort study analysed the incidence and characteristics of injuries, illnesses and medication use during the 2020 COSAFA Women's Championship. METHODS The medical personnel of all participating teams reported all new injuries, illnesses and medication used by players daily. RESULTS Sixty-three injuries were reported: 45 match and 18 training injuries; 45.5 (95% CI: 32.2 to 58.8) injuries/1000 match-hours and 21.7 (95% CI: 11.7 to 31.7) injuries/1000 training-hours, respectively. Most (n = 55, 87%) were caused by contact with another player and involved the lower extremity (n = 43; 68%). Fifty-eight illnesses were reported: 44.4 (95% CI: 33.0 to 58.8) illnesses/1000 player-days, mostly diarrhoea (n = 25; 43.1%) and dysmenorrhoea (n = 18; 31%). No cases of COVID-19 were reported. In total, 175 medications were prescribed: 168.8 (95% CI: 143.8 to 193.8) medications/1000 player-days. Non-steroidal anti-inflammatory drugs (NSAIDs) (n = 60; 34.3%) and analgesics (n = 33; 18.9%) were the most commonly prescribed drugs. CONCLUSION Incidences of injury and illnesses were high but time loss was low, likely due to high NSAIDs use. Further studies should be conducted in order to inform appropriate prevention or management protocols in this population.
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Affiliation(s)
- Nonhlanhla S Mkumbuzi
- Health through Physical Activity, Lifestyle, and Sports Research Centre(HPALS). Department of Human Biology, University of Cape Town, Observatory, South Africa.,African Evaluation and Research Development, Johannesburg
| | - Senanile B Dlamini
- Health through Physical Activity, Lifestyle, and Sports Research Centre(HPALS). Department of Human Biology, University of Cape Town, Observatory, South Africa
| | - Fidelis Chibhabha
- Anatomy Department, Faculty of Medicine, Midlands State University, Gweru, Zimbabwe
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The Prevalence and Impact of Debilitative Psychological and Behavioral Responses to Long-Term Injury in Athletes. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2022. [DOI: 10.1123/jcsp.2021-0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Injuries, and their psychological and maladaptive behavioral consequences, are an inevitable by-product of sport participation. This study sought to investigate the prevalence of maladaptive behaviors and psychological corollaries of long-term injury in order to understand if these are universal experiences of long-term injured athletes. Competitive athletes (n = 187; average time spent injured =43 weeks), across a range of sports completed an online questionnaire developed to investigate the psychological and behavioral consequences of long-term injury. Results indicated that negative symptoms after injury were a universal experience and are the “normal” response to injury, not the “exception.” The most prevalent psychological consequences were rumination (97.9%), boredom (94.7%), and fear of reinjury (93.6%). Furthermore, indicators of suicidal ideation were reported by more than 50% of participants. Factor analysis revealed a six-factor model: (a) self-sabotaging behavior, (b) daily functioning, (c) addictive behavior, (d) clinical issues, (e) fixation on injury, and (f) compromised athletic identity. All factors significantly correlated with debilitating impact. Thus, this study calls for a change to the support of long-term injured athletes to include routine psychological care.
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Bedrin MD, Putko RM, Dickens JF. Analgesia in Athletes: A Review of Commonly Used Oral and Injectable Modalities. Sports Med Arthrosc Rev 2021; 29:e71-e76. [PMID: 34730120 DOI: 10.1097/jsa.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pain is common among athletes at all levels and the treatment of pain can be a challenging and frustrating task. The team physician needs a fundamental knowledge of analgesic strategies as it relates to athletes. It is important to understand the mechanism of action, side effect profile/associated complications, incidence of and indications for use, as well as the controversies associated with the most common analgesic medications used in sports medicine. Several "in vogue" treatment modalities, including cannabidiol, are also becoming more commonly used and are worth discussion.
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L’usage du cannabidiol dans le sport : une bonne idée ? Sci Sports 2021. [DOI: 10.1016/j.scispo.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Barcelos RP, Lima FD, Courtes AA, da Silva IK, Vargas JE, Royes LFF, Trindade C, González-Gallego J, Soares FAA. Diclofenac Administration after Physical Training Blunts Adaptations of Peripheral Systems and Leads to Losses in Exercise Performance: In Vivo and In Silico Analyses. Antioxidants (Basel) 2021; 10:antiox10081246. [PMID: 34439494 PMCID: PMC8389246 DOI: 10.3390/antiox10081246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 12/19/2022] Open
Abstract
Recovery in athletes is hampered by soreness and fatigue. Consequently, nonsteroidal anti-inflammatory drugs are used as an effective strategy to maintain high performance. However, impact of these drugs on adaptations induced by training remains unknown. This study assessed the effects of diclofenac administration (10 mg/kg/day) on rats subjected to an exhaustive test, after six weeks of swimming training. Over the course of 10 days, three repeated swimming bouts were performed, and diclofenac or saline were administered once a day. Trained animals exhibited higher muscle citrate synthase and lower plasma creatinine kinase activities as compared to sedentary animals, wherein diclofenac had no impact. Training increased time to exhaustion, however, diclofenac blunted this effect. It also impaired the increase in plasma and liver interleukin-6 levels. The trained group exhibited augmented catalase, glutathione peroxidase, and glutathione reductase activities, and a higher ratio of reduced-to-oxidized glutathione in the liver. However, diclofenac treatment blunted all these effects. Systems biology analysis revealed a close relationship between diclofenac and liver catalase. These results confirmed that regular exercise induces inflammation and oxidative stress, which are crucial for tissue adaptations. Altogether, diclofenac treatment might be helpful in preventing pain and inflammation, but its use severely affects performance and tissue adaptation.
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Affiliation(s)
- Rômulo Pillon Barcelos
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (A.A.C.); (I.K.d.S.); (F.A.A.S.)
- Programa de Pós-Graduação em Bioexperimentação (PPGBioexp), Universidade de Passo Fundo (UPF), BR 285, Passo Fundo 99052-900, Brazil
- Correspondence: (R.P.B.); (C.T.)
| | - Frederico Diniz Lima
- Laboratório de Bioquímica do Exercício, Centro de Educação Física e Desportos, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (F.D.L.); (L.F.F.R.)
| | - Aline Alves Courtes
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (A.A.C.); (I.K.d.S.); (F.A.A.S.)
| | - Ingrid Kich da Silva
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (A.A.C.); (I.K.d.S.); (F.A.A.S.)
| | - Jose Eduardo Vargas
- Laborátorio de Biologia Molecular, Instituto de Ciências Biológicas (ICB), Universidade de Passo Fundo (UPF), Passo Fundo 99052-900, Brazil;
- Hospital de Clínicas de Porto Alegre, Programa de Pós-Graduação Ciências em Gastroenterologia e Hepatologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-003, Brazil
| | - Luiz Fernando Freire Royes
- Laboratório de Bioquímica do Exercício, Centro de Educação Física e Desportos, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (F.D.L.); (L.F.F.R.)
| | - Cristiano Trindade
- Facultad de Ciencias Básicas y Biomédicas, Universidad Simón Bolívar, Barranquilla 080002, Colombia
- Correspondence: (R.P.B.); (C.T.)
| | - Javier González-Gallego
- Institute of Biomedicine (IBIOMED) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of León, 24071 León, Spain;
| | - Félix Alexandre Antunes Soares
- Programa de Pós-Graduação em Bioquímica Toxicológica, Centro de Ciências Naturais e Exatas, Departamento de Bioquímica e Biologia Molecular, Universidade Federal de Santa Maria, Santa Maria 97105-900, Brazil; (A.A.C.); (I.K.d.S.); (F.A.A.S.)
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Brennan R, Wazaify M, Shawabkeh H, Boardley I, McVeigh J, Van Hout MC. A Scoping Review of Non-Medical and Extra-Medical Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Drug Saf 2021; 44:917-928. [PMID: 34331260 PMCID: PMC8370940 DOI: 10.1007/s40264-021-01085-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications worldwide and have analgesic, antipyretic and anti-inflammatory properties. Although NSAIDs are recognised as generally safe and effective, non-medical and extra-medical use of these products can occur. Unlike the use of illegal and many prescription drugs, which are subject to extensive research attention, inappropriate use of NSAIDs has been less well investigated. This scoping review collates and describes what is known regarding non-medical and extra-medical use of NSAIDs. In total, 72 studies were included in this scoping review. Three themes emerged from the review: (1) indicative profile of people who engage in non-medical or extra-medical use of NSAIDs; (2) antecedents for non-medical or extra-medical use; and (3) adverse health effects of non-medical and extra-medical use of NSAIDs. The review concluded that there is a need for enhanced patient education, including among sports people; pharmacovigilance in terms of clinician recognition of aberrance; and prescriber and pharmacist awareness of the potential for extra-medical and non-medical use and the related health harms.
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Affiliation(s)
- Rebekah Brennan
- School of Applied Social Studies, University College Cork, Cork, Ireland.
| | - Mayyada Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Haneen Shawabkeh
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Ian Boardley
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jim McVeigh
- Substance Use & Associated Behaviours, Department of Sociology, Manchester Metropolitan University, Manchester, UK
| | - Marie Claire Van Hout
- Faculty of Health, Public Health Institute, Liverpool John Moore's University, Liverpool, UK
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Fernandes GS, Parekh SM, Moses JP, Fuller CW, Scammell BE, Batt ME, Zhang W, Doherty M. Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Med 2021; 50:1039-1046. [PMID: 31925768 PMCID: PMC7142039 DOI: 10.1007/s40279-019-01255-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA). Methods This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA). Results 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40–2.34) and TKR (OR 2.21, 95% CI 1.43–3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85–2.01). Given, the association with KP and TKR, we found a significant dose–response relationship as the more injections a player received (by dose–response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01). Conclusion On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.
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Affiliation(s)
- Gwen S Fernandes
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
| | - Sanjay M Parekh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Jonathan P Moses
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Colin W Fuller
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Colin Fuller Consultancy Ltd, Sutton Bonington, LE12 5PE, UK
| | - Brigitte E Scammell
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Mark E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK.
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
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Gultekin S, Chaker Jomaa M, Jenkin R, Orchard JW. Use and Outcome of Local Anesthetic Painkilling Injections in Athletes: A Systematic Review. Clin J Sport Med 2021; 31:78-85. [PMID: 30789366 DOI: 10.1097/jsm.0000000000000716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of local anesthetic painkilling injections to improve player availability is common practice in elite-level sport. OBJECTIVE To document the published use of local anesthetic injections in sport, according to number of injections, sites of injections, and complications reported. DATA SOURCES A systematic search of MEDLINE, Embase, CINAHL, AMED, Cochrane Database of Systematic reviews, SportDiscus, EBSCO Host, and Google Scholar. RESULTS One thousand nine hundred seventy local anesthetic injections reported on 540 athletes in 10 studies (from rugby league, American football, Australian football, and soccer) were reviewed. The most common areas of injection were as follows: the acromioclavicular (AC) joint; hand (including fingers); sternoclavicular joint (including sternum); rib injuries; and iliac crest contusions. DISCUSSION This review found some evidence of long-term safety for a limited number of injection sites (eg, AC joint) and some evidence of immediate complications and harmful long-term consequences for other sites. The quality of evidence is not high, with little long-term data and a lack of independent verification of the effects of the injections. Ideally, long-term follow-up should be conducted to determine whether these injections are safe, with follow-up undertaken independently of the treating physician and team. CONCLUSIONS Based on limited publications, there is some evidence of long-term safety; however, there is a lack of clear proof of either absolute safety or long-term harm for many of these procedures. Physicians and players in professional sport should proceed with caution in using local anesthetic injections.
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Affiliation(s)
| | | | | | - John W Orchard
- School of Public Health, University of Sydney, Sydney, Australia
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Gamelin FX, Cuvelier G, Mendes A, Aucouturier J, Berthoin S, Di Marzo V, Heyman E. Cannabidiol in sport: Ergogenic or else? Pharmacol Res 2020; 156:104764. [DOI: 10.1016/j.phrs.2020.104764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/04/2020] [Accepted: 03/18/2020] [Indexed: 12/12/2022]
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15
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Lai-Cheung-Kit I, Lemarchand B, Bouscaren N, Gaüzère BA. Consommation des anti-inflammatoires non stéroïdiens lors de la préparation au Grand Raid 2016 à La Réunion. Sci Sports 2019. [DOI: 10.1016/j.scispo.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Professional Footballers’ Association Counselors’ Perceptions of the Role Long-Term Injury Plays in Mental Health Issues Presented by Current and Former Players. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2019. [DOI: 10.1123/jcsp.2018-0049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to investigate counselors’ professional understanding of the long-term psychological consequences of injury in UK football players. Semi-structured interviews were conducted with 11 counselors who were registered to work for the Professional Footballers’ Association (PFA). The interviews examined the counselors’ perception of the relationship between long-term injury and presenting mental health issues, the antecedents to those mental health issues, and recommendations for psychological intervention following injury. The critical finding was the mental health problems regularly presented to PFA counselors were often the psychological and behavioral consequences of long-term injury. Counselors recommended that early and sustained psychological intervention with long-term injured players would act as a preventative measure against future mental health issues.
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Oester C, Weber A, Vaso M. Retrospective study of the use of medication and supplements during the 2018 FIFA World Cup Russia. BMJ Open Sport Exerc Med 2019; 5:e000609. [PMID: 31548910 PMCID: PMC6733315 DOI: 10.1136/bmjsem-2019-000609] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2019] [Indexed: 12/21/2022] Open
Abstract
Objective Examine the intake of medication and supplements used by top-level players during the 2018 FIFA World Cup Russia. Participants 736 top-level players Setting The team doctors uploaded a list of the medications used by each player to the online reporting tool within 72 hours of each match of the 2018 FIFA World Cup Russia. Outcome measures Average number of medications used per player per match and during the tournament; average number and percentage of players using at least one medication per match and during the tournament. Results 54% of the players took at least one medication during the tournament and 39% took at least one medication before each match. The most used medications were non-steroidal anti-inflammatory drug (NSAID) (38.6%), followed by other analgesics (13.8%) and medications for insomnia and anxiety (13%). On average, 0.72 medications were taken per player per match and 1.32 per player during the tournament. The mean number of medication intake per player per match was higher during the knockout stage compared with the group stage (0.88±1.36 vs 0.65±1.08, p<0.001). Players from South America and North and Central America took more medications per match compared with the players from Africa (0.9±1.14 and 0.98±1.1 vs 0.48±0.83, p<0.001 in both cases). Conclusion The intake of NSAIDs decreased during the 2018 FIFA World Cup compared with previous FIFA World Cups, but stayed at a high level. The high number of medications taken is a cause for concern, and therefore, players, medical staff and coaches should be made more aware of the possible side effects of a high medication intake.
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Affiliation(s)
- Chelsea Oester
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Alexis Weber
- Fédération Internationale de Football Association, Zurich, Switzerland
| | - Martin Vaso
- Fédération Internationale de Football Association, Zurich, Switzerland
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18
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Schobersberger W, Blank C, Budgett R, Pipe A, Stuart MC. Compliance with needle-use declarations at two Olympic Winter Games: Sochi (2014) and PyeongChang (2018). Br J Sports Med 2019; 54:27-32. [DOI: 10.1136/bjsports-2018-100342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 11/04/2022]
Abstract
ObjectivesWe describe compliance with the ‘IOC Needle Policy’ at two Winter Olympic Games (Sochi and PyeongChang) and compare these findings to those of the Summer Olympic Games of Rio de Janeiro.MethodAll needle-use declaration(s) (NUD) received during the course of the 2014 and 2018 Olympic Games were reviewed. We recorded socio-demographic data, the nature and purpose of needle use, product(s) injected, and route of administration. Data were analysed descriptively.ResultsIn total, doctors from 22 National Olympic Committees (NOCs) submitted 122 NUD involving 82 athletes in Sochi; in PyeongChang, doctors from 19 NOCs submitted 82 NUD involving 61 athletes. This represented approximately 2% of all athletes at both Games, and 25% and 20% of all NOCs participating in Sochi and PyeongChang, respectively. No marked differences in the NUD distribution patterns were apparent when comparing the two Winter Olympic Games. The most commonly administered substances were as follows: local anaesthetics, non-steroidal anti-inflammatory drug and glucocorticoids. Physicians submitted multiple NUD for 24% of all athletes who required a NUD.ConclusionA limited number of NOCs submitted NUD suggesting a low incidence of needle use or limited compliance (approximately 2%). A key challenge for the future is to increase the rate of compliance in submitting NUD. More effective education of NOCs, team physicians and athletes regarding the NUD policy, its purpose, and the necessity for NUD submissions, in association with the enforcement of the appropriate sanctions following non-compliance are needed.
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Endurance Performance is Influenced by Perceptions of Pain and Temperature: Theory, Applications and Safety Considerations. Sports Med 2018; 48:525-537. [PMID: 29270865 DOI: 10.1007/s40279-017-0852-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Models of endurance performance now recognise input from the brain, including an athlete's ability to cope with various non-pleasurable perceptions during exercise, such as pain and temperature. Exercise training can reduce perceptions of both pain and temperature over time, partly explaining why athletes generally have a higher pain tolerance, despite a similar pain threshold, compared with active controls. Several strategies with varying efficacy may ameliorate the perceptions of pain (e.g. acetaminophen, transcranial direct current stimulation and transcutaneous electrical stimulation) and temperature (e.g. menthol beverages, topical menthol products and other cooling strategies, especially those targeting the head) during exercise to improve athletic performance. This review describes both the theory and practical applications of these interventions in the endurance sport setting, as well as the potentially harmful health consequences of their use.
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Abstract
OBJECTIVE To identify the prevalence, frequency of use, and effects of analgesic pain management strategies used in elite athletes. DESIGN Systematic literature review. DATA SOURCES Six databases: Ovid/Medline, SPORTDiscus, CINAHL, Embase, Cochrane Library, and Scopus. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Empirical studies involving elite athletes and focused on the use or effects of medications used for pain or painful injury. Studies involving recreational sportspeople or those that undertake general exercise were excluded. MAIN RESULTS Of 70 articles found, the majority examined the frequency with which elite athletes use pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anesthetics, and opioids. A smaller set of studies assessed the effect of medications on outcomes such as pain, function, and adverse effects. Oral NSAIDs are reported to be the most common medication, being used in some international sporting events by over 50% of athletes. Studies examining the effects of pain medications on elite athletes typically involved small samples and lacked control groups against which treated athletes were compared. CONCLUSIONS Existing empirical research does not provide a sufficient body of evidence to guide athletes and healthcare professionals in making analgesic medication treatment decisions. Based on the relatively robust evidence regarding the widespread use of NSAIDs, clinicians and policymakers should carefully assess their current recommendations for NSAID use and adhere to a more unified consensus-based strategy for multidisciplinary pain management in elite athletes. In the future, we hope to see more rigorous, prospective studies of various pain management strategies in elite athletes, thus enabling a shift from consensus-based recommendations to evidence-based recommendations.
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21
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Novel Factors Associated With Analgesic and Anti-inflammatory Medication Use in Distance Runners: Pre-race Screening Among 76 654 Race Entrants-SAFER Study VI. Clin J Sport Med 2018; 28:427-434. [PMID: 29944515 DOI: 10.1097/jsm.0000000000000619] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Analgesic/anti-inflammatory medication (AAIM) increases the risk of medical complications during endurance races. We determined how many runners use AAIM before or during races, AAIM types, and factors associated with AAIM use. DESIGN Cross-sectional study. SETTING 21.1-km and 56-km races. PARTICIPANTS Seventy-six thousand six hundred fifty-four race entrants. METHODS Participants completed pre-race medical screening questions on AAIM use, running injury or exercise-associated muscle cramping (EAMC) history, and general medical history. MAIN OUTCOME MEASURES Analgesic/anti-inflammatory medication use, types of AAIM (% runners; 95% confidence interval), and factors associated with AAIM use (sex, age, race distance, history of running injury or EAMC, and history of chronic diseases) [prevalence ratio (PR)]. RESULTS Overall, 12.2% (12.0-12.5) runners used AAIM 1 week before and/or during races (56 km = 18.6%; 18.0-19.1, 21.1 km = 8.3%; 8.1-8.6) (P < 0.0001). During races, nonsteroidal anti-inflammatory drugs (NSAIDs) (5.3%; 5.1-5.5) and paracetamol (2.6%; 2.4-2.7) were used mostly. Independent factors (adjusted PR for sex, age, and race distance; P < 0.0001) associated with AAIM use were running injury (2.7; 2.6-2.9), EAMC (2.0; 1.9-2.1), cardiovascular disease (CVD) symptoms (2.1; 1.8-2.4), known CVD (1.7; 1.5-1.9), CVD risk factors (1.6; 1.5-1.6), allergies (1.6; 1.5-1.7), cancer (1.3; 1.1-1.5), and respiratory (1.7; 1.6-1.8), gastrointestinal (2.0; 1.9-2.2), nervous system (1.9; 1.7-2.1), kidney/bladder (1.8; 1.6-2.0), endocrine (1.5; 1.4-1.7), and hematological/immune (1.5; 1.2-1.8) diseases. CONCLUSIONS 12.2% runners use AAIM before and/or during races, mostly NSAIDs. Factors (independent of sex, age, and race distance) associated with AAIM use were history of injuries, EAMC, and numerous chronic diseases. We suggest a pre-race screening and educational program to reduce AAIM use in endurance athletes to promote safer races.
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Abstract
OBJECTIVE For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge. DATA SOURCES Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified. MAIN RESULTS Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life. CONCLUSIONS The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.
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Schifano F, Chiappini S, Corkery JM, Guirguis A. Abuse of Prescription Drugs in the Context of Novel Psychoactive Substances (NPS): A Systematic Review. Brain Sci 2018; 8:E73. [PMID: 29690558 PMCID: PMC5924409 DOI: 10.3390/brainsci8040073] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/11/2018] [Accepted: 04/20/2018] [Indexed: 02/07/2023] Open
Abstract
Recently, a range of prescription and over-the-counter drugs have been reportedly used as Novel Psychoactive Substances (NPS), due to their potential for abuse resulting from their high dosage/idiosyncratic methods of self-administration. This paper provides a systematic review of the topic, focusing on a range of medications which have emerged as being used recreationally, either on their own or in combination with NPS. Among gabapentinoids, pregabalin may present with higher addictive liability levels than gabapentin, with pregabalin being mostly identified in the context of opioid, polydrug intake. For antidepressants, their dopaminergic, stimulant-like, bupropion activities may explain their recreational value and diversion from the therapeutic intended use. In some vulnerable clients, a high dosage of venlafaxine (‘baby ecstasy’) is ingested for recreational purposes, whilst the occurrence of a clinically-relevant withdrawal syndrome may be a significant issue for all venlafaxine-treated patients. Considering second generation antipsychotics, olanzapine appears to be ingested at very large dosages as an ‘ideal trip terminator’, whilst the immediate-release quetiapine formulation may possess proper abuse liability levels. Within the image- and performance- enhancing drugs (IPEDs) group, the beta-2 agonist clenbuterol (‘size zero pill’) is reported to be self-administered for aggressive slimming purposes. Finally, high/very high dosage ingestion of the antidiarrhoeal loperamide has shown recent increasing levels of popularity due to its central recreational, anti-withdrawal, opiatergic effects. The emerging abuse of prescription drugs within the context of a rapidly modifying drug scenario represents a challenge for psychiatry, public health and drug-control policies.
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Affiliation(s)
- Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - John M Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
| | - Amira Guirguis
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK.
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Milano G, Chiappini S, Mattioli F, Martelli A, Schifano F. β-2 Agonists as Misusing Drugs? Assessment of both Clenbuterol- and Salbutamol-related European Medicines Agency Pharmacovigilance Database Reports. Basic Clin Pharmacol Toxicol 2018; 123:182-187. [DOI: 10.1111/bcpt.12991] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit; University of Genoa; Genoa Italy
| | - Stefania Chiappini
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit; School of Life and Medical Sciences; University of Hertfordshire; Hatfield UK
- Casa di Cura Villa Rosa; Viterbo Italy
| | - Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit; University of Genoa; Genoa Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit; University of Genoa; Genoa Italy
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit; School of Life and Medical Sciences; University of Hertfordshire; Hatfield UK
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Ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism. Proc Natl Acad Sci U S A 2018; 115:E715-E724. [PMID: 29311296 PMCID: PMC5789927 DOI: 10.1073/pnas.1715035115] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Concern has been raised over increased male reproductive disorders in the Western world, and the disruption of male endocrinology has been suggested to play a central role. Several studies have shown that mild analgesics exposure during fetal life is associated with antiandrogenic effects and congenital malformations, but the effects on the adult man remain largely unknown. Through a clinical trial with young men exposed to ibuprofen, we show that the analgesic resulted in the clinical condition named "compensated hypogonadism," a condition prevalent among elderly men and associated with reproductive and physical disorders. In the men, luteinizing hormone (LH) and ibuprofen plasma levels were positively correlated, and the testosterone/LH ratio decreased. Using adult testis explants exposed or not exposed to ibuprofen, we demonstrate that the endocrine capabilities from testicular Leydig and Sertoli cells, including testosterone production, were suppressed through transcriptional repression. This effect was also observed in a human steroidogenic cell line. Our data demonstrate that ibuprofen alters the endocrine system via selective transcriptional repression in the human testes, thereby inducing compensated hypogonadism.
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Didier S, Vauthier JC, Gambier N, Renaud P, Chenuel B, Poussel M. Substance use and misuse in a mountain ultramarathon: new insight into ultrarunners population? Res Sports Med 2017; 25:244-251. [PMID: 28114830 DOI: 10.1080/15438627.2017.1282356] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Endurance and ultra-endurance events have become increasingly popular. The aim of our study was to explore the use of medication among endurance runners participating in the 2014 Infernal Trail des Vosges. Among the 389 runners engaged, 297 (76.3%) completed a specific questionnaire dealing with substance use/misuse. Our results show a 27% (before the race) and 18% (during the race) prevalence of substance use. The two major classes of substances used were non-steroidal anti-inflammatory drugs (NSAIDs; 9.8%) and painkillers (6.7%), principally because of osteo-articular pain (29.6%) or to prevent pain (28.2%). A positive correlation was found between substance consumption before (past month) and during the race (overall medication: p < 0.0001; NSAIDs: p = 0.008). Our results could be explained by the specific characteristics of ultrarunners predominantly motivated by personal achievement and general health (recreational approach). However, education interventions should further be delivered regarding the risks of substance use in ultra-endurance events.
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Affiliation(s)
- Sandra Didier
- a Department of General Practice , Maison de Santé des Trois Monts , Dommartin-les-Remiremont , France
| | - Jean-Charles Vauthier
- a Department of General Practice , Maison de Santé des Trois Monts , Dommartin-les-Remiremont , France
| | - Nicolas Gambier
- b Department of Clinical Pharmacology and Toxicology , CHRU Nancy , Nancy , France
| | - Pierre Renaud
- c Department of Pulmonary Function Testing and Exercise Physiology , CHRU Nancy , Nancy , France
| | - Bruno Chenuel
- c Department of Pulmonary Function Testing and Exercise Physiology , CHRU Nancy , Nancy , France.,d EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control , Université de Lorraine , Nancy , France
| | - Mathias Poussel
- c Department of Pulmonary Function Testing and Exercise Physiology , CHRU Nancy , Nancy , France.,d EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory regulations and motor control , Université de Lorraine , Nancy , France
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