High school athletes wanting to return to the field too soon from injury could begin a cycle that leads to addiction to pain medication, according to Dr. Sarem Narouze, a clinical professor of anesthesiology and pain management at Ohio University, and clinical professor of neurological surgery at Ohio State University.
“When they go back to practice and play too early, they get re-injured,” he said. “Which then can mean another exposure to pain medication.”
Narouze said narcotics should only be given as a last resort, and only for severe acute pain like fractures and after surgery. “They should be prescribed for short course only to facilitate recovery and physical therapy,” he said, adding, “if we have good control of acute pain, then we can avoid chronic pain.”
He listed alternatives to the opiates. Doctors typically prescribe rest and activity modification; ice/cold (depending on the injury); pain analgesics such as ibuprofen; prescription anti-inflammatory medication; physical therapy; adjuvants (opioid-sparing medications; which include muscle relaxants; nerve membrane stabilizers or anti-seizures); or small doses of anti-depressants, he said.
For patients with long rehabilitation, peripheral nerve blocks – -using local numbing medicine — can help improve compliance with physical therapy, the anesthesiologist said.
Painkillers are to be used for the short course, only with close monitoring, such as two to four weeks. “But if it’s more than that, [the doctor] should re-check the diagnosis,” Narouze said. “Maybe I am missing something. I must diagnose and treat the cause of the pain rather than numb the pain.”
Dr. Chris Stankovich, a Columbus, Ohio-based counselor for student-athletes, recommends adding psychological work to combat pain, such as “imagery, positive self-talk, setting goals, and journaling your progress to see results, which in turn builds confidence.”
He also says to look at what is pushing a young athlete to take painkillers to play through the pain.
“Kids don’t want to lose their opportunity for scholarship, or their starting position when they’re injured,” he said. “They also see a number of elite level athletes returning to play earlier.”