FIFA warns about the abuse of painkillers

Jiri Dvorak, FIFA Chief Medical Officer talks
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FIFA’s Chief Medical Officer Professor Jiri Dvorak has said that the ‘abuse’ of painkillers could put the careers and long-term health of footballers in jeopardy.

During the 2010 FIFA World Cup South Africa™, FIFA’s Medical Department asked team doctors to provide a list of medications which players were taking prior to each game. Previous surveys at international tournaments established that many players were using large numbers of painkilling and non steroidal anti-inflammatory drugs.

The results from South Africa 2010, published recently in the British Journal of Sports Medicine, show higher levels of use than ever before. Indeed, 39 per cent of all players took painkillers before every game.

Experts warn that painkilling medication can be particularly dangerous in professional sport. In high-intensity exercise like football, a player's kidneys are continuously working hard, making them more vulnerable to damage from strong drugs. During South Africa 2010, FIFA initiated a study about painkillers, and the results are now available. Can you summarise the results of this study? Prof Jiri Dvorak: Since 1998 we’ve collected data about the intake of medication for all players at every FIFA tournament, which roughly equates to 55 competitions from U-17 tournaments to senior club and national team competitions. The results are striking. Even at U-17 level, between 20-25 per cent of players are taking anti-inflammatory drugs and painkillers and this increases to senior World Cup levels, which sees 30-35 per cent of usage. When we combine that with the usage of non steroidal anti-inflammatory drugs, it equates to about half of the players.

Some of the players are probably taking this medication without a prescription from the team doctors, they’re just taking them and then telling the doctor. Others are taking them under prescription from the doctors as they’re suffering some kind of pain or discomfort. But other players could also be using these painkillers in advance to reduce the pain caused by potential discomfort during a match. That could be dangerous.

By masking symptoms through painkillers, you could be covering something which could be important in the long run.

*At the recent Medical Conference in Budapest, you “warned” the players not to abuse taking painkillers (and supplements). What are the dangers for players? *First of all, we need to raise awareness with the physicians responsible for the teams in all member associations so they think twice before prescribing this type of medication. Every medication you take has potential side effects, such as the building of blood content, but it could also have a negative effect on the function of the liver and kidneys, particularly if a particular medication has been taken for a long time. Some of the medications can also irritate the gastro-intestinal tract which can lead to internal bleeding of different magnitudes.

Is there, or should there be, a clear and strong regulation about the use of painkillers?
This is not up to FIFA, it’s up to WADA. While we have knowledge about the misuse or abuse of these painkillers, we have to focus on education. Our duty is to educate medical and paramedical personnel and players. They have to understand that if discomfort or pain is being suffered, it means that something is not functioning correctly. By masking symptoms through painkillers, you could be covering something which could be important in the long run. For example, small cartilage lesions can lead to larger lesions and this could lead to the early onset of osteo-arthritis.

Every individual needs time for rehabilitation and recuperation and that leads to the obvious question ‘are they playing too much?’ or ‘are they under too much pressure to play?’ Doctors and players are under pressure from managers and coaches for economical or sporting reasons , but it should be realised that every individual takes a different amount of time to recover. Above all however, is that football should be promoted as a health-enhancing activity and that’s why our primary concern is the health of players.

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