I'm not an expert but everything I've read on the topic points to how they don't work at all for performance enhancement. Also, for long races like long distance triathlon or road cycling you'd be hurting yourself.
NSAIDs reduce gastric blood flow - which isn't exactly what you want during such a long race.

That true but the Opioids family is linked to constipation, that could definitely be useful in a long distance race 💩

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I'd be fine with all non-nutritional drugs being banned from competition.

I do carry a couple paracetamol with me on each long distance race just in case I feel something acting up that I feel might bother me in an hour or two. I probably end up taking them in one out of four long distance races.

 

just cause some kind of doping might be within the rules doesn't make it ok.

google alex mcgregor

Ibuprofen would increase your HR and blood pressure plus have an adverse effect on your stomach, definitely not recommended. Also when I have a migraine-type-headache 1-2 days before a race and take ibuprofen, my race is compromised (HRV is lower, resting HR is higher, HR during race is 5-10 beats higher than normal).

Paracetamol is easy on stomach and heart, but heavy on a liver. I wouldn’t know how much worse would it be in a dehydrated state. I also wouldn’t do it.

There’s a (potential) myth on a preventive effect on heart of small dose aspirin for men over 50-60 in a race. It apparently decreases the performance marginally, but could save somebody from a heart malfunction.

The bottom line of what I think is: too many people think of improving performance by 1% by also harming themselves by 5%. keep training, there’re gains to be made for 99.99% of you

Plus exertion when under the influence of NSAIDS can cause kidney damage. Do it too often and you could land on the transplant list. No idea if the risk is significant if you only use it in racing (even very long and strenuous racing).

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There's plenty of non-nutritional drugs that should be allowed, notwithstanding the squishiness off the definition. Some drugs like antihistamines really help a lot of people with allergies just to be outside, let alone compete, and have no tangible performance benefit. Others like caffeine are so ubiquitous that banning them would effectively condemn the entire field.


(I don't think it's worth worrying about, but from an abundance of caution there is some research to suggest that taking painkillers before/during endurance events can lead to kidney damage)

As I remember, Tramadol will bring down inflammation and make you feel better so you can train more.

So not a direct performance enhancer like epo but it can help you train more.

With that said, I was given Tramadol when i had a pulmonary embolism a few years ago. It was the only thing that eased the pain. I took 3 of them over 3 days and disposed of the rest. Kind of wished I'd have kept them. But that's a slippery slope.

I was prescribed Tramadol for some protruding disc issues a few years back and wound up injured while running because the drug was blocking a pain signal that would otherwise have told me to back off, slow down, or stop. Pain, as unpleasant as it is, has an important purpose and trying to mask it and "push through" can have unintended consequences. I think it's foolish to train with these medications.

.
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Tramadol will be added to the banned substance list as of Jan 1st 2024. It is already banned in cycling due to rampant abuse by Pro-Tour teams to allow athletes to back up training day after day.
Tramadol: Why some athletes and experts want it banned in sport | USADA

In 2017 I had a bad crash in Thailand was prescribed an awesome cocktail of Tramadol,Celebrex and Asprin to deal with badly broken ribs and other assorted injuries. Those drugs worked a treat and I could see why the pro tour was all over them, but they probably weren't too good for a concussion and TBI that was never diagnosed and treated at the time. Being Thailand,access to those drugs was easy and by the end of the first month I was hooked.Took months to beat the dependance and years for my brain to start working properly again. (six years later and my ribs still hurt sometimes).

If you consider Tylenol or Acetaminophen a painkiller, it has shown to have some performance enhancing effects. I've known of a couple people that have used it. I've tried it 2-3 timed during training and never really noticed much.

https://runningmagazine.ca/health-nutrition/does-acetaminophen-improve-endurance-performance/

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As an AG athlete, I couldn't get past the long term health ramifications of taking something. I guess some athletes will try to win or improve at any cost - not worth it in my mind, even if I was a pro.

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I've had it prescribed in the past as well. Just to counter a couple of things mentioned...
1. I'd argue that it is -definitely- a direct performance enhancer, as it makes you feel good, dulls the pain. That will help you in any race, etc. And further, I'd say it is less beneficial for training, because, yes it will let you train harder for a given session, but once the drug wears off, your muscles will have been beat to shit and need more time to recover. I remember a couple of training runs I did while having it in my system (to be clear, no, it was not in my system -for- the running...), and the difference was pretty noticeable. And I was pretty darn sore the next day lol.

2. To the person who said you need boat loads of caffeine to offset the drowsy effect, that is not true in my brief experience using it. It did an excellent job dulling pain, and did not make me the least bit tired. If pro cyclists are combining caffeine with it, it is not to counteract a drowsy effect, it is simply to get that extra boost from the caffeine.

I was not at all surprised when several years ago I read about it being used by pro cyclists. Really, anything that actually works, that isn't banned, pro cyclists will take it!
I wouldn't be one bit surprised if many pro triathletes are popping them before the run portion of races......Ooooops....I forgot, triathlon is a clean sport...... ;)

Great piece by Dr Stephen Cheung, 13 years old, but entirely on-point, including a nod to the ethical dimension of the issue.
https://pezcyclingnews.com/...crank-down-the-pain/

you guys all know that luc van lierde had a blister pack of aspirins poking out of his waistband when he won kona (and set the course record) back in '96 . . . right?

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Was that the year he left the island early? :)

I don't believe most amateurs are capable of using proven doping strategies to make themselves faster.

It seems even more unlikely that they are going to use more improbable doping techniques to their benefit.

Celebrex + aspirin combined is a strange combination for pain relief. Mainly because Celebrex is a COX-2 specific NSAID, it is given to specifically target the COX-2 inflammatory pathways that are causative from a pain perspective. Aspirin is more non specific in terms of COX targeting. There is no reason to use them together if it is just for analgesia. Were you on the aspirin to potentially prevent blood clots etc as well?

I will chime in with a hopefully authoritative view on some aspects of this.
My job is as an anesthesiologist, which to those who don't know too much about what we do, it is basically applied pharmacology and applied physiology, along with a lot of acute and chronic pain management.
Firstly, on the issue of paracetamol/acetaminophen. It is very safe and you need to use considerable doses to really have an effect on your liver. Generally 90mg/kg per 24 hours are safe. We will use a loading dose of 30mg/kg in an acute pain setting or in the peri-operative setting. If I am carrying an injury etc and have to function I will often pop 1.5 grams myself. You really run into problems from a liver perspective when you go above this 90 mg/kg/24hours. So taking some before and during races should not be too much of an issue.
Secondly: anti-inflammatories. These are often ideal as pain relief for many sports related injuries and therefore commonly used to help get people through races. But, they have significant issues and you really need to be careful. The biggest one to be worried about in a racing and training environment is the effects of dehydration combined with NSAIDs on renal blood flow, and hence the ability to cause an acute kidney injury. You have to be super careful and really careful in terms of your fluid management. I personally took some during an Ironman as I was fighting some niggles on the run so took them before hopping off the bike, but I would be loathe to recommend this to others. They have well known effects on your gastric mucosa and can cause ulcers and gastritis, so some people need to take them with something to protect their stomach lining, like ranitidine or omeprazole. (not sure what the USA terms are for these). They are also not recommended in people with hypertension although still commonly used as generally we need these medications in elderly patients with arthritis etc.
Thirdly: opiate/partial opiate agonists (ie tramadol). Tramadol is a partial opioid agonist that also has effects on a few other pain pathways. I have to admit to being surprised when I first read about this being used in cycling. Then I guess it made sense, not so much as a direct performance enhancer, but more so a performance enhancer because of its greater ability to dull pain than "simple" analgesics. As others have mentioned, the drug can cause some sleepiness, but this really depends on the individual tolerance to it and the dose used. We don't find drowsiness a big issue in normal clinical use. You can easily combat this with some caffeine if needed, but I don't think you will find the cyclists using massive doses of caffeine to counteract this effect. Those that have used it may be able to agree with this next statement-the side effects can be incredibly variable. We have a distinct group of patients who just refuse to ever use it again as it made them feel horrible. They can get all sorts of neurological/cognitive side effects like inability to sleep, hallucinations etc from it. These are unpredictable, you never quite know who is going to get that. I have rarely used this myself from an injury perspective, in part as I have been prescribed other things normally. We definitely see more of these adverse side effects in our female population.

There are other partial opioid agonists that are out there which are commonly used for analgesia, including Palexia (tapentadol) and Temgesic (Buprenorphine). Only buprenorphine and tramadol are on the 2024 WADA list so I imagine that tapentadol may become the default go to agent in this regard. It is a much newer agent to all the others but I am surprised it has not made the WADA list.

A 2.02 marathoner got busted for pethidine recently

I’m totally against nsaid use during training or racing. There’s too many studies out there showing bad stuff for me to risk messing with it. Yeah, I probably could have trained harder or perhaps raced faster, but I’m happy to get through without. That said I get sometimes weekly headaches and 2 ibuprofen is the only thing that cures them.

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Thank you for sharing this from the professional point of view. I’m appreciating it a lot.

Also, I’m actually surprised with the safety of using paracetamol and its dosage limits, in general. My stand in AG competition remains unchanged - go look for marginal gains somewhere else. But in EU typical pill is 500mg, with max daily dosage of 3000mg. Apart from being 24h after an operation, I’ve never even needed to reach that limit. The 90mg/kg/24h seems crazy high. Also, if you load paracetamol for a race, you better stick to athletic brewing after the race.

Question on ibuprofen an its adverse side effect on kidneys: does hydration matter in a sense of pure filtration or in an athletic sense (h2o plus minerals)? E.g. drinking carb free sodium free soda doesn’t much help performance hydration, but does it prevent from those side effects? I’m beyond comprehending this.

Will answer this in two parts.
Firstly, paracetamol.
There is obviously a difference in terms of what we can use and prescribe in a highly controlled environment versus what information the general public will be given dose wise and for overall safety.
Here in Australia and NZ the “standard” daily limit is 4000mg. We see people go over that but it is still generally safe and not really a massive issue in one off situations, or in a race situation and with some alcohol. To overdose on paracetamol you do need a reasonable amount in one hit and it’s an absolutely horrible way to go. Horrible.
NSAIDS are interesting. Here in Australia for instance we don’t tend to go over 1200mg per day of ibuprofen. I was reading/revieiwng a study from the USA last week for publication and was figuring out why they had such a dramatic analgesic effect from a relatively small dose of opioid in this particular surgical population, then I took another look at the fine detail of their methodology, and they were using up to 3200mg per day of ibuprofen, ie 800ng four times a day. Far in excess of what we would use here!!
In terms of the kidney issues with NSAIDS, it’s not so much a direct kidney toxic effect of the drug itself, it’s more what the drugs do to renal blood flow and hence how this can be further compromised in cases of significant dehydration. I would have to go back to my basic pharmacology to look at what you are saying the carbs and electrolytes, it’s not something I think about too much in my line of work except when we deal with our big bleeding cases and more elderly patients.
I should have said earlier, am not trying to give advice to people on how to safely use NSAID’s and paracetamol, more just what we do surgically and how I do this myself. I get people’s fears over nsaids and racing and training, and there will always be horror stories. However I think with how widespread their use is that they are generally pretty safe for most people. But a hot marathon/ultra/ironman then be warned!
I have had one mate get rhabdo as well doing a 100km ultra in a super hot race….

I agree about the risk but I wouldn't be surprised if people still do it. There was an article awhile back on the NFL's rampant use of toradol (ketorolac):

https://thelab.bleacherreport.com/...-use-players-survey/

As far as triathlon goes, I don't think it's on the WADA list? I'm a bit surprised from a safety standpoint even though it isn't addictive.