Little harm seen from painkiller shots for pro athletes

• Pain • • Trauma • Jul 30, 10

When professional athletes in sports like football and rugby are injured, they commonly get injections of pain-numbing anesthetics to help them stay in the game. Now a new study suggests that, while safety concerns remain, most athletes may not suffer any long-term harm from the practice.

Injections of local anesthetics, like bupivacaine and lidocaine, temporarily block sensation in a limited area around the injection site.

While the injections have long been used in some pro sports to keep athletes in the game, the practice has only been “presumed” to be generally safe—with few studies having actually looked at the question, according to the researchers on the new work.

A main concern is that the injections could worsen the initial injury by allowing an athlete to play through it, explained lead researcher Dr. John W. Orchard, an adjunct associate professor at the Sydney School of Public Health, University of Sydney in New South Wales, Australia.

There are also other potential downsides. An injection to the knee or groin area, for instance, could unintentionally block a major motor nerve and leave a player temporarily unable to run or kick. And there are some injuries for which an anesthetic shot may be too risky; with tendon injuries, for example, injections could lead to a rupture in the tendon.

However, very little has been known about how the typical pro athlete fares long-term after having one or more injuries treated with anesthetic shots.

For their study, Orchard and his colleagues surveyed 341 athletes who had played with the top three “grades” of the Sydney Roosters rugby team over 10 seasons—of whom 100 had ever received an injection of a local anesthetic (mostly bupivacaine) in order to compete. Orchard, the team doctor, administered most of the injections.

When asked, nearly all of the treated players—98 percent—said they would repeat the treatment if they suffered the same injury again. That was despite the fact that one-third felt that they’d had side effects, including 6 percent who thought they’d worsened the injury by competing, and 22 percent who felt that their recovery time had probably been extended.

The most serious problems included one player who had an injection for a bone bruise in the wrist and then suffered a full fracture; another who had a tendon injury that progressed to a full rupture after having injections to allow him to be in two playoff games; and a player who had four injections to the base of the thumb and said he still had chronic instability in the joint years later.

However, Orchard’s team found, 72 percent of the athletes said they had no long-term pain in the area where they had been treated with anesthetic injections. And only 1 percent said they had daily pain; most with lingering pain described it as “an occasional niggle but nothing too severe.”

The study, published in the American Journal of Sports Medicine, is what is known as a case series—where researchers track a group of patients given a similar treatment.

Such studies have a number of shortcomings that limit the conclusions that can be drawn from them. They lack, for example, a “control” group of patients who did not receive the treatment, which is important for helping to determine whether an effect can be ascribed to the treatment itself.

“I wouldn’t say that this case series is definitive proof that any particular injection is 100-percent safe,” Orchard told Reuters Health in an email.

But, he added, the study followed the athletes for a much longer time than previous studies have. And the findings, Orchard said, offer “some reassurance” that at least for certain injuries, anesthetic injections are “fairly safe” in the long term.

Orchard also pointed out that these are professional athletes, and there may be certain circumstances under which players are willing to take the risk of worsening an injury. Whereas it would be inappropriate for an amateur athlete to take that chance, it may be reasonable for an NFL player competing in the Super Bowl.

Of the rugby players in this study, most said they decided to have an anesthetic injection because they did not want to miss a game or did not want to play in pain; only 7 percent said they based the decision on the doctor’s recommendation or on “pressure from the coach.”

Still, players’ decisions should be based on a clear understanding of the potential risks versus benefits. According to Orchard and his colleagues, it is “incumbent” upon the governing bodies in professional sports to fund further studies of the long-term safety of anesthetic injections.

SOURCE: American Journal of Sports Medicine, online July 1, 2010.