After reading this chapter, the student should:
Have a basic history of analgesics and anesthetics.
Understand the rationale for treating pain.
Be able to differentiate between analgesics and anesthetics.
Understand the rationale for the use of prescription and over-the-counter (OTC) analgesics.
Be able to differentiate between opioid and nonopioid analgesics.
Understand the physician's role in the prescription and monitoring of analgesics.
Be able to determine the warning signs of improper use of analgesics by athletes.
Understand how local anesthetics can be delivered to the athlete.
Understand the proper use of local anesthetics in athletics.
Be cognizant of the adverse effects of analgesics and anesthetics.
This chapter outlines the use of pain-relief preparations and their appropriate application in sports. The team physician should always be the person responsible for advising athletes regarding pain relief and prescribing these drugs. Sometimes athletes, coaches, and others will self-prescribe or encourage the use of analgesics or local anesthetics to allow players to participate in a contest. When recommending an analgesic or anesthetic to allow an athlete to participate in a practice or competition, the athletic trainer must be aware of the ramifications of this action. It is not our intention to outline the instances when using analgesic or anesthetic methods to allow a player to participate would be justified. We feel that participation by an injured athlete is a decision that must be made by the individual athlete in consultation with the team physician. It is well recognized that analgesics and anesthetics should not be used when further tissue damage is expected or may occur.
When an athlete experiences pain, this is an intrinsic signal from a body part indicating that something is wrong at some level in one or more of the tissues. The team physician should evaluate pain signals lasting more than a few days and refer the athlete to a specialist in pain management when it is deemed necessary. Injured athletes experiencing pain for short periods of time (less than a day) can use an over-the-counter (OTC) analgesic for short-term relief. If an athlete is in continuous pain for more than a day, he or she should seek the advice of a physician. The World Health Organization (WHO) has outlined a three-step approach to the management of pain. Table 10–1 outlines these recommended steps.
Table 10-1World Health Organization Pain Management Hierarchy |Favorite Table|Download (.pdf) Table 10-1 World Health Organization Pain Management Hierarchy
|Severity of Pain ||Drug Use |
|Mild to moderate ||NSAIDs or acetaminophen |
|Moderate to severe ||Opioid for mild to moderate pain, plus a nonopioid adjuvant drug* |
|Severe ||Opioid at higher dose for moderate to severe pain plus nonopioid adjuvant drug |