Pain Killers on Game Day: When Winning Can Mean Losing

By Dr. Peter Abaci

The NFL finds itself under legal attack once again, this time accused of pushing pain killer misuse among players. Last week multiple news sources reported that over 500 ex-players filed a lawsuit against the NFL for damages related to health problems from the over-use and misuse of pain killers used to keep them playing while injured. Some players reported repeatedly being doled out opioid-based, or narcotic, medications without appropriate prescriptions leading to problems with addiction. Others claim they were given narcotics or anti-inflammatory medications to keep them playing without being told that they actually had broken bones. The years of free pills and unmonitored injections are now being blamed for significant chronic diseases in addition to pain killer addiction.

One of the medications being brought up in this controversy is actually not a narcotic at all, but the potent anti-inflammatory Toradol, also known as ketorolac. Toradol is in the family of non-steroidal anti-inflammatory drugs (NSAID), which includes commonly used pain killers like ibuprofen. What makes Toradol unique is that it can be delivered as an injection and it is very potent. In fact, intravenous Toradol is just as effective as intravenous morphine for acute or post-surgical pain. Since it is unlikely to interfere with a player’s performance the way a narcotic would on game day, you can see why it gained popularity in the NFL. 

The problem is that continuous use of Toradol is contraindicated because of the side effects associated with repeated intake. The risks are considered to be much higher if it is used for more than 5 days in a row. Possible complications include excessive bleeding, ulcers, and even acute renal failure. Consider the article run by the Washington Post last year on painkiller abuse in the NFL which portrayed rampant dependence on game day injections in order to play in what is a very physically and emotionally demanding sport. The Post quoted retired NFL veteran Mark Schlereth on his playing days as follows:

“Bottom line is, I’d do whatever I have to do. Have I had Toradol shots? Yes. Have I abused anti-inflammatories? Yes. Have I used painkillers? Yes. Have I got shot up with painkillers and Xylocaine and different things to numb areas so I can play? Yes. I’ve done it all.”

One of the players involved in the current lawsuit is retired center Jeremy Newberry who contends that he suffered significant kidney damage as a result of ongoing pain killer injections with Toradol. Reports indicate that he first showed signs of kidney problems on laboratory tests back in 2004 that were largely ignored by team physicians, yet he continued to receive regular pain killer injection for several seasons after that. He has now been advised by his current physician that he has serious kidney problems with only about 30% of function remaining. 

Many players feel that without these injections they wouldn’t be able to play on a week to week basis, but how many out there in the working world resort to less than ideal health habits in order to keep working and provide for their families? Many a patient has told me over the years that they feel they need things like pain killers, sleeping pills, or anxiety pills in order to be able to work each day. I’ve heard this from all walks of life including carpenters, farm workers, salesman, and even lawyers. But in the real world, where do doctors and their patients draw the line between making choices that seem to help in the short-term but potentially hurt in the long-term, especially when it pertains to being able to earn a living? 

Certainly, the hundreds of players in this lawsuit would have liked to have had a sit-down with a doctor during their playing days to talk about the long-term ramifications of what they were doing. Clearly, this is a discussion all pain patients should have with their doctors, too, as these same drugs can also cause the same health problems for them as it does for professional athletes. 

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