ABUSE OF ANTI-INFLAMMATORIES IN SPORTS

Non-steroidal anti-inflammatory drugs

The drugs used to treat inflammation are called anti-inflammatories. One of the main classes of anti-inflammatory drugs is NSAIDs (non-steroidal anti-inflammatory drugs).
The acronym NSAID therefore means the set of substances with anti-inflammatory, analgesic and antipyretic action with a non-steroidal molecular structure. These substances compete with arachidonic acid in binding cyclooxygenase (COX), the enzyme responsible for the first step in the production of numerous molecules involved in the inflammatory process.
The so-called arachidonic acid cascade is at the basis of inflammatory processes, in fact the body produces the so-called eicosanoids from arachidonic acid: prostaglandins, prostacyclines, leukotrienes and thromboxanes. These substances are involved in cellular defense and repair processes, consequently they are produced whenever an external stimulus (infection, mechanical damage, thermal or chemical stress, etc.) tends to damage a certain tissue.
NSAIDs are the main medical tool to combat inflammation. They are in fact used in the treatment of rheumatic and non-rheumatic diseases such as rheumatoid arthritis and osteoarthritis, but also tendinitis, bursitis, and in any case in all those manifestations affecting the system musculoskeletal sustained by the presence of inflammatory phenomena, consequently also in the event of an injury resulting from sports practice.

Abuse of NSAIDs: Side Effects

The excessive use and chronic use of anti-inflammatories can lead to several side effects such as:

gastric damage with ulceration of the mucous membranes due to the reduced production of gastroprotective prostaglandins;

nephritis, impaired renal function and renal complications due to the flaking of the renal epithelium;

liver damage;

blockage of platelet aggregation and consequent haemorrhage due to the reduced production of thromboxanes;

inhibition of uterine motility;

hypersensitivity reactions to NSAIDs (see allergy to salicylates)

Use and abuse of NSAIDs in sports

The use of anti-inflammatories in sports is absolutely justified in the treatment of the numerous injuries generated by sports. Athletes in fact use these drugs to relieve discomfort caused by trauma, to reduce the symptoms of muscle, tendon, bone and joint inflammation.
NSAIDs do not fall into the classes of substances prohibited by anti-doping regulations, therefore athletes can use them without incurring disciplinary sanctions. In fact, these substances are also routinely used by professional athletes to relieve inflammation, injuries and acute pains caused by sports. However, in many cases, athletes use these drugs incorrectly and inappropriately.
Anti-inflammatory therapy to heal injuries, which should only be followed for 5/8 days, is often continued for several weeks. The continued prolonged use of anti-inflammatories many times creates the side effects previously described. However, the athlete tries to recover quickly from the injury to the detriment of the health of the rest of the body.
Research conducted in several countries clearly shows that there is a wide use of NSAIDs, sometimes unjustified, by athletes. Often the athlete uses these medicines without consulting the doctor; this behavior can lead to inappropriate therapies that can lead to abuse and can lead to damage to health. This practice often proves to lack the medical requirements regarding the dosages used, duration of treatment and appropriateness of use. All this can easily lead to the onset of the numerous side effects described. The use of NSAIDs has become so natural that the numerous negative effects which are unfortunately only taken into account when they occur are often not considered.
If the analgesic effect is already evident in the hours after taking the NSAID, the situation regarding the anti-inflammatory action is very different and more complex. In fact, several weeks of therapy may be required to treat inflammation resulting from trauma. and injuries, in particular for those caused by sports. Consequently, the therapeutic intervention is also prolonged excessively, obviously entailing a greater risk of the appearance of side effects. This situation, often complicated also by the lack of medical supervision, is often the cause of the abuse of these medicines.
In addition, athletes also use anti-inflammatories to be able to compete in less than optimal physical conditions. Many athletes take NSAIDs in order to compete or even simply train even in the presence of pain, joint inflammation, trauma, etc. This determines an absolutely incorrect use of these drugs which can lead to serious damage to health: doing physical activity and even competing under the action of NSAIDs reduces the perception of pain, consequently an athlete not feeling the discomfort of a possible injury is led to over-strain the injured area risking to worsen the situation, as it simply does not feel the effects of the inflammation, but has not resolved the event. Generally an inflammatory state promotes pain sensations whenever the inflamed area is stimulated, while under the effect of NSAIDs the pain is not perceived and the athlete strains the area in question thus increasing the disturbance, which will be perceived again as such when the effects of the drug fade.
Using anti-inflammatories to promote healing from injuries, traumas, bruises, tendinitis, etc., is correct from a therapeutic point of view, however undergoing further physical exertion under the effect of these drugs leads to aggravate existing injuries.
It should also be added that some studies show that the use of NSAIDs improves endurance performance, through mechanisms not yet known, and this often represents another reason for NSAID abuse.
A possible explanation for this effect can be hypothesized on the fact that prostaglandins also act in the central nervous system, in fact it seems that they increase the inhibitory gabaergic activity of the nervous system, therefore the action of anti-inflammatories, reducing the activity of the gabaergic system, activates the nervous system consequently increasing the physical work capacity. In addition, type E prostaglandins reduce the adrenergic activity, consequently the action of anti-inflammatories, which inhibit the release of these prostaglandins, also in this case it can stimulate the nervous system by strengthening the "adrenergic activity. These effects could give possible benefits, also in terms of improving physical abilities.
The abuse of NSAIDs by athletes is, for the above reasons, a very common practice that can lead to numerous health risks. To avoid these risks it is therefore essential to consult a doctor before undertaking any drug therapy.