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Non-Steroidal Anti-Inflammatory Drug Use in Collegiate Athletes

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Non-Steroidal Anti-Inflammatory Drug Use in Collegiate Athletes Portland State University PDXScholar Dissertations and Theses Dissertations and Theses Summer 8-4-2015 Non-Steroidal Anti-Inflammatory Drug Use in Collegiate Athletes Brian Robert Davis Portland State University Follow this and additional works at: https://pdxscholar.library.pdx.edu/open_access_etds Part of the Other Public Health Commons, and the Sports Sciences Commons Let us know how access to this document benefits ou.y Recommended Citation Davis, Brian Robert, "Non-Steroidal Anti-Inflammatory Drug Use in Collegiate Athletes" (2015). Dissertations and Theses. Paper 2477. https://doi.org/10.15760/etd.2474 This Thesis is brought to you for free and open access. It has been accepted for inclusion in Dissertations and Theses by an authorized administrator of PDXScholar. Please contact us if we can make this document more accessible: [email protected]. Non-Steroidal Anti-Inflammatory Drug Use in Collegiate Athletes by Brian Robert Davis A thesis submitted in partial fulfillment of the requirements for the degree of Masters of Science in Health Studies Thesis Committee: Gary Brodowicz, Chair James Wallis Jonathan Huwe Randy Logan Portland State University 2015 Abstract Non-steroidal anti-inflammatory drugs (NSAID) are a class of medications used in the treatment of pain, inflammation, and illness. These medications are common, affordable, and easy to access. For these reasons, NSAIDs are commonly used by athletes of all backgrounds for treating injuries and as ergogenic aids. However, despite these behaviors, NSAIDs have well-documented side effects and the efficacious nature of these medications has been brought into question. Despite this, many athletes continue to use these medications frequently and indiscriminately. It is not known why athletes use these medications in light of their questionable effectiveness and cited adverse effects. Therefore, this study was designed to (1) further investigate the prevalence of NSAID use in collegiate-level athletes, (2) investigate attitudes and behaviors toward the use of NSAIDs cross-tabulated by sport, gender, and competition level, and (3) investigate athletes’ general knowledge of NSAIDs. Subjects for this study included 79 student-athletes (44 male; 25 female) attending Portland State University (PSU). The majority of the athletes started taking NSAIDs before high school (72% of the males and 64% of the females). Thirty-three percent of males and 32% of females reported that they had been taking NSAIDs within the past week. High in-season use of NSAIDs was reported by 52% of the male athletes and 48% of the female athletes, whereas off-season use was reported by 21% and 12% of the males and females, respectively. Cited reasons for NSAID use both in-season and off-season were relief of pain due to injury, prevention, recovery, soreness, and tightness. In total, 83% of males and 76% of females reported obtaining NSAIDs primarily through means i other than health-care professionals. With regard to dosage, athletes reported taking NSAIDs based on product directions, instructions of an athletic trainer or perceived pain levels. An overwhelming majority of athletes (83% male; 76% female) were not aware of any side-effects from taking NSAIDs In summary, this study revealed a pattern of high NSAID use in athletes competing in-season compared to a high prevalence of low NSAID use in athletes off- season. It also revealed a high prevalence of non-prescription NSAID use. Additionally, there was a high prevalence of self-purchasing of NSAIDs, combined with self- medication and a long history of NSAID use. This study also revealed a general lack of knowledge about NSAIDs. ii Table of Contents Abstract…………………………………………………………………………………… .. i List of Tables………………………………………………………………………............v List of Figures…………………………………………………………………………….vi Glossary………………………………………………………………………………….vii Chapter 1 Introduction………………………………………………………………………………...1 Introduction……………………………………………………………………….. .1 Statement of Problem……………………………………………………………....2 Purpose……………………………………………………………………………. .2 Chapter 2 Review of Literature……………………………………………………………………… …4 General Information on NSAIDs…………………………………………………. .. 4 NSAID Use in Athletic Populations……………………………………………… …5 Reasons for Use in Athletes………………………………………………………. .. 8 Efficacy of NSAIDs……………………………………………………………... .. 10 Adverse Effects………………………………………………………………….. ..13 Guidelines for Use………………………………………………………………. .. ..... 19 Future Research/Recommendations……………………………………………...21 Chapter 3 Methods…………………………………………………………………………………..22 General Overview……………………………………………………………….. ...... 22 Subjects…………………………………………………………………………....... 22 iii Eligibility Criteria……………………………………………………………….. ...... 23 Data Collection……………………………………………………...................... ......... 23 Variables………………………………………………………………………… …… 25 Data Analysis…………………………………………………………………..... ..... 26 Chapter 4 Results…………………………………………………………………………………… .. 27 Chapter 5 Discussion……………………………………………………………………………….. ..... 38 Limitations………………………………………………………………………. ...... 42 Conclusion……………………………………………………………………..... ......... 42 References……………………………………………………………………………….. .. 44 Appendices……………………………………………………………………………..... .60 Appendix A. Survey Instrument…………………………………………............ ........ 60 Appendix B. Consent Form…………………………………………………............... 67 Appendix C. Human Subjects Approval………………………………………… .69 Appendix D. Table 2. Survey Response Data………………………………........71 iv List of Tables Table 1. Subject Descriptive Data………………………………………………………. ..27 v List of Figures Figure 1. Summary of responses to question 2 (“When did you first use NSAIDs?”).………………………………………………………………….. .29 Figure 2. Summary of responses to question 5 (“Are you currently taking any NSAIDs?” ) and question 6 (“Are you currently taking NSAIDs that were prescribed to you by a doctor or medical professional (Physical therapist, Athletic trainer, etc. )?...................................................................................... .30 Figure 3. Summary of responses to question 8 (“How often do you use NSAIDs while competing IN-SEASON?” ), and question 9 ( “How often do you use NSAIDs while training in the OFF-SEASON?” ). High = “Frequently” + “Regularly”; Low = “Infrequently”………………………………………………………...31 Figure 4. Summary of responses to question 10 (“What are your reasons for using NSAIDs while competing IN-SEASON?”) and question 11 (“ What are your reasons for using NSAIDs while training in the OFF-SEASON?”)..……….. .34 Figure 5. Summary of responses to question 12 (“From whom do you PRIMARILY receive your NSAIDs?”). ……………………………………………………...35 Figure 6. Summary of responses to question 13 (“How do you TYPICALLY determine the dose of NSAIDs to take at a given time?”).……………………………... .36 Figure 7. Summary of responses to question 15 (“Have you heard of NSAIDs causing any side effects?” )……………………………………………………………37 vi Glossary Cyclooxygenase (COX): Enzyme responsible for the formation of prostaglandins. Delayed Onset Muscle Soreness (DOMS): Pain and stiffness felt in muscles several hours to days after unaccustomed or strenuous exercise. Inflammation: The body’s initial response to harmful stimuli, which quarantines the area and initiates the healing process. Symptoms of inflammation include pain, redness, swelling, heat, and loss of function. Non-Steroidal Anti-Inflammatory Drugs (NSAID): Medications that have analgesic (pain relieving), antipyretic (fever-reducing), antithrombotic (blood-thinning), and anti- inflammatory properties. These drugs can either be prescribed or purchased over-the- counter (OTC). Over-the-Counter (OTC): Medications that can be purchased and administered without a prescription. Prophylactic: Guarding from or preventing the spread or occurrence of something. Prostaglandins (PG): Fatty acid derivatives that are important in the regulation of inflammation vii Chapter 1 Introduction Introduction Competitive athletes at all levels typically put in a great deal of time and effort to meet the physical demands of their sports. While athletes work to meet these demands, their bodies are at increased risk of injury. In 2002, 20.3 million sports-related injuries were estimated to have occurred in the U.S., or 70.5 injuries per 1000 persons (Warden, 2005). Because athletic endeavors are associated with a high amount of physical stress and injury, athletes rely on various methods to help minimize possible negative effects of training and competition. One of the most popular methods used by athletes to assist with athletic-ailments is the use of non-prescription pain relievers, specifically, non-steroidal anti-inflammatory drugs (NSAID) (Lanier, 2004; Ziltener, Leal, & Fournier, 2010). NSAIDs are a class of analgesic (pain relieving) medications used in the treatment of pain, inflammation, and illness. NSAIDs are well-known for being relatively cheap and easy to access as most of these medications can be purchased over-the-counter (OTC) at various general stores and pharmacies. NSAIDs are not only popular with athletes due to their affordability and ease of access, but also due to the social acceptability of their use, their ease of administration, and high amounts of observed use by peers (clinicians, parents, friends, siblings, etc.) (Holmes, Cronholm, Duffy, & Webner, 2013; Warner, Schnepf, Barrett, Dian, & Swigonski, 2002). Thus, NSAIDs are used at one’s leisure without fear of repercussions or stigmatization (Holmes et al., 2013; Warner et al., 2002). It is for these 1 reasons, NSAIDs are a popular drug of choice for athletes treating painful
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