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Pain and Addiction on the Sidelines


How can athletes avoid pain and addiction post-surgery?

As a sports-neurologist and pain medicine specialist, I have specific expertise in the management of chronic pain in athletes. Unfortunately, with this expertise, I bear too-frequent witness to the dual-heartbreak of athletes who experience a season- or career-halting injury and subsequent surgery, only to have it be accompanied by pain and opioid addiction. Thankfully, recent and crucial research examines this actual and dangerous occurrence in athletes at all levels of play. What this clinical study uncovers helps researchers shed light on specific problems. At the same time, it illuminates alternatives so that athletes can heal, recover, and return to the game or return to living a life free from pain and addiction.

First, I must note that despite our focus on the COVID pandemic, opioid addiction in the United States remains a significant problem faced by people who engage in sports, as well as those who don't. The reasons for the addiction are as unique as the people who are taking this class of medications – whether the medicines are prescribed or obtained illicitly. I carve out the athletic population from others because I believe it is essential to observe this group's uniqueness – in the hopes that we may be able to learn from and help to prevent pain from substance abuse that turns into addiction.

For most athletes who have undergone reparative surgery for a sports injury, some form of pain relief is often necessary. Historically, common prescriptions for post-surgical pain have come in the form of an opioid. And this is mainly because many prescribing physicians learned in medical school that adequate pain relief is achievable only by prescribing one of these powerful opioid drugs. But today, new research is bringing alternatives to the forefront. Indeed, appropriate pain relief can be achieved for post-surgical pain with a variety of non-opioid pain relievers and other non-medication strategies. Some medication alternatives include anti-inflammatories, nerve pain interceptors, and adjuvants to reduce muscle tension or spasticity associated with guarding.

While there may remain cases where an athlete's pain should be managed with an opioid – reliable and effective alternatives allow physicians to minimize use of opioid medications. In some instances, we can even try a less risky option first and then switch to an opioid if the pain is still not properly managed. That is a huge win for patients.

We also have tools to help athletes (and other people in pain) overcome pain with options that don't involve medication therapy. I've written extensively on and wholeheartedly believe in highly effective non-medication strategies for pain management. Non-medication strategies include neuromodulation (applying a stimulus such as focused cold, electrical or magnetic energy to nerves that reduces pain), as well as manual therapies like massage, regional cryotherapy, and even mindfulness meditation or virtual reality sessions that quiet the autonomic system and reduce pain.

A neurologist's approach to pain is based on a thorough knowledge of how the body works and how the brain contributes to suffering from pain; not just how medications or injections can mask the pain. Our goal is to help our patients manage pain so that they can continue to live their everyday lives, or in this case get back to sports careers they love. In cases of post-surgical pain this can simply be a matter of time for the surgical site to heal, or it can mean nerve or other damage that requires further evaluation.

Tragic stories of opioid abuse and overdose among talented athletes have captured the headlines on sports magazine covers and websites as well as impactful television docuseries for years. These are people who devoted a career to a sport – only to be robbed of it by injury, surgery, and then by addictive drugs that were supposed to help them get back to a game or life they loved. In other cases, after retirement from sport, individuals suffer from uncontrolled or poorly treated painful conditions that expose them to opioids, depression, and risk of addiction. Now that we as a medical community know better, we can do better for athletes and every patient who needs to get back into the game and/or workplace after injury and surgery. Once a decision for surgery has been made, management of the pain associated with the intervention matters. We know opioid addiction continues to be a significant problem in our country, and even the most elite athletes aren't immune to it. Health care providers, coaches, and athletic trainers must work together to support our athletes' recovery after surgery. Whether we are an athlete, construction worker, or first responder, we all deserve the opportunity to pursue our best lives without the albatrosses of constant pain and addiction.