Orthopedists, sports medicine physicians urged to consider pros and cons of game-day pain medication injections

Game-day injections of pain relief medications can be beneficial for some athletes, but there is still a considerable risk for complications if they are not administered correctly or if the athlete does not comply with his doctor’s guidelines, according to a new clinical review.

“All soft tissue injections for pain control, whether [you use] a corticosteroid, local anesthetic or nonsteroidal anti-inflammatory drug (NSAID) like Toradol, have potentially serious side effects that must be considered, especially in pregame settings,” lead author Matthew Matava, MD, associate professor of orthopedics at Washington University School of Medicine, said in a press release.

The review appears in the September/October issue of Sports Health: A Multidisciplinary Approach.

Matava and his team analyzed current information on the use of corticosteroids (cortisone), local anesthetic pain relief agents and the NSAID ketorolac tromethamine (Toradol).

They suggested it is critical that the sports medicine professional be aware of the different agents and their varying pharmacologic characteristics. For example, some investigators studying the efficacy of local corticosteroid injections said they were effective in some studies, while other study results refuted those findings and demonstrated an increase in complications such as a ruptured tendon, according to the press release.

General recommendations for corticosteroid injections include using them only after other nonsurgical treatments have failed and a when a palpable location for the pain is apparent. Cortisone shots can be extremely detrimental if given immediately after an injury, before a competitive event or in the presence of an infection, the investigators wrote.

Local anesthetics such as lidocaine allow for an immediate assessment of pain relief and can serve as a confirmatory diagnostic method when the source of discomfort or injury is in question. Allergic reaction is one of the most common complications with this form of pain relief in athletes, and injecting these agents into an injured tendon or ligament is likely to increase the risk for ruptures or other degenerative processes, Matava said in the press release.

Toradol is the only NSAID currently available in an intramuscular or intravenous form in the United States, according to the press release. The increased bleeding risk with high levels of Toradol is especially significant in collision sports such as football.

“Even a small increase in bleeding risk can exacerbate high-risk injuries such as concussions, spinal cord, spleen and kidney trauma. Toradol injections before a game should be carefully weighed versus the emotional ramifications of an impending game,” Matava said in the press release.

Reference:
Nepple JJ, Matava MJ. Soft tissue injections in the athlete. Sports Health: A Multidisciplinary Approach. doi:10.1177/1941738109343159.