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Prophylactic misuse and recommended use of
non-steroidal anti-inflammatory drugs by athletes

Stuart J Warden Br. J. Sports Med. 2009;43;548-549; originally published online 9 Jan 2009; doi:10.1136/bjsm.2008.056697 Updated information and services can be found at: References
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Articles on similar topics can be found in the following collections To order reprints of this article go to: British Journal of Sports Medicine selectively of the agent.8–10 As the adversegastrointestinal and cardiovascular effects associated with NSAIDs become morepronounced with increased duration ofuse, athletes risk serious side effects by using NSAIDs prophylactically for pro-longed periods. This is further com- approximately 10% of those who useNSAIDs take up to five different com-pounds concomitantly.3 4 11 terms of blocking pain before it occurs.5 activities such as each player touching a winning streak. These practices are rela- athletes to inadvertently allow pathology petition anxiety, but a concerning ritual the prophylactic use of non-steroidal anti- the synthesis of the extracellular matrix isozymes and, in particular, the inhibition the rate-limiting step in the formation of synthesis immediately before or following mechanical stimuli.13 14 Athletes who reg- have reduced tissue adaptation to prevail- ing loads potentially predisposing them to is unsafe. In addition to participating in lactic use of NSAIDs has the potential to subsequent tissue repair following micro- diovascular functions. As a result, NSAID athletic endeavours, but more recent data suggest athletes misuse their open accessto NSAIDs. Tscholl and colleagues4recently reported in this journal that23% of top-level male football playersused NSAIDs in two out of three matchesduring the 2002 and 2006 Fe´de´rationInternationale de Football AssociationWorld Cup tournaments and that morethan 10% of players took NSAIDs beforeevery match. These data suggest thatmany athletes use NSAIDs prophylacti-cally and presumably for prolonged peri-ods. This hypothesis is supported by thefinding that high-school level Americanfootball players who take NSAIDs daily Correspondence to: Dr Stuart J Warden, Departmentof Physical Therapy, School of Health and RehabilitationSciences, Indiana University, 1140 W Michigan St, CF- Decision tree for the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) to 326, Indianapolis, IN 46202, USA; stwarden@iupui.edu athletes with an acute or chronic musculoskeletal injury.
Rostom A, Dube C, Lewin G, et al. Nonsteroidal anti- inflammatory drugs and cyclooxygenase-2 inhibitors for primary prevention of colorectal cancer: a be as effective as NSAIDs at treating acute systematic review prepared for the U.S. Preventive musculoskeletal pain.23 Alternatively, at- Services Task Force. Ann Intern Med2007;146:376–89.
risk athletes may be offered the option of Tscholl P, Feddermann N, Junge A, et al. The use and abuse of painkillers in international soccer: data that regular use of NSAIDs reduces injury from 6 FIFA Tournaments for female and youth gastroprotection.9 Ultimately, there is no players. Am J Sports Med 2009;37:260–5.
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NSAIDs for clinical indications (ie, inju- Alaranta A, Alaranta H, Helenius I. Use of prescription drugs in athletes. Sports Med ries, rather than prophylactically) is the Ferry ST, Dahners LE, Afshari HM, et al. The effects observation that their negative effect on of common anti-inflammatory drugs on the healing rat Corrigan B, Kazlauskas R. Medication use in athletes patellar tendon. Am J Sports Med 2007;35:1326–33.
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Prevalence, attitudes, and behaviors related to the pulsed ultrasound accelerates and a nonsteroidal anti- use of nonsteroidal anti-inflammatory drugs (NSAIDs) inflammatory drug delays knee ligament healing.
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indeed indicated (fig 1), its use should be Ekman EF, Ruoff G, Kuehl K, et al. The COX-2 specificinhibitor valdecoxib versus tramadol in acute ankle prostaglandin synthesis with NS-398 has different restricted to the minimal dose and for the sprain: a multicenter randomized, controlled trial.
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Woo WW, Man SY, Lam PK, et al. Randomized Mitchell JA, Warner TD. COX isoforms in the double-blind trial comparing oral paracetamol and oral cardiovascular system: understanding the activities of nonsteroidal antiinflammatory drugs for treating pain Athletes with a history of side effects or non-steroidal anti-inflammatory drugs. Nat Rev Drug after musculoskeletal injury. Ann Emerg Med risk factors for side effects with NSAIDs

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