Pain Treatment in Marathon & Ultramarathon Runs
Marathoners and Ultrarunners Risk Hyponatremia with Aspirin & NSAIDs
Oct 6, 2009
In marathon and ultramarathon runs legs pound repeatedly. Muscles repeat the same motions tens of thousands of times. Feet rubbing against shoes can induce mega-blisters. Many view 26.2 mile marathons as ultimate endurance runs. Marathons however pale compared to 50 to 100 mile distances of many ultramarathons. Ultramarathon runners push their bodies to the limits.
There will be pain!
Pain Treatment
Runners hitting the wall in marathons or doing the predawn death march of the 100, may hurt in places they didn't even know they had. Marathon and ultramarathon runners are, however, a stubborn bunch. Runners refusing to quit the race have two options for dealing with the pain:
- Take pain medications, often in large doses.
- Gut it out.
Runners choosing to take pain medications often take aspirin, ibuprofen, or other non steroidal anti-inflammatory drugs, NSAIDs. Over the counter pain relievers are usually safe. NSAIDs help reduce the inflammation in muscles and joints thereby helping to reduce the cause of the pain as well as masking the pain.
NSAIDs would seem the perfect treatment for pain management in long endurance runs. Many marathon runners and ultrarunners take ibuprofen, aspirin, or other NSAIDs for pain treatment while running. There are, however, risks.
Risks of NSAIDs in Marathons and Ultramarathons
Occasionally pain during endurance runs signals impending injury. Runners masking their pain with pain killers risk not feeling the pain of an impending injury. Runners might choose to withdraw from the race to avoid injury. Medicated runners, by running longer, risk finishing the race at the price of a severe overuse injury. Many runners are willing to take this risk, but they should recognize this risk of pain medications and allow adequate recovery time after races.
Runners taking NSAIDs also run the more severe risk of developing hyponatremia during a long endurance run.
Risk of Hyponatremia
Hyponatremia is a potentially fatal condition that occasionally occurs in marathon runners, ultrarunners, ironman triathletes, and other endurance athletes. Hyponatremic runners have sodium concentrations that are too low, which can happen when runners replace fluids without replacing electrolytes, including sodium. Often the kidneys shut down, making it difficult to eliminate fluids, which could help increase sodium concentrations. Excess fluids cause swelling in the extremities and the brain, which can lead to coma or death.
Because they affect the kidneys it seems that NSAID might increase the risk of hyponatremia. Multiple studies suggest that use of NSAIDs during marathons or ultramarathons is a risk factor in developing hyponatremia.
A study by D.P. Davis et al. in the July 2001 issue of the Journal of Emergency Medicine finds that NSAID use is a risk factor for hyponatremia along with female gender, excess fluid consumption, and slow race times.
A study in the April 2006 issue of Medicine & Science in Sports & Exercise by P.C. Wharam et al. finds that even though the overall incidence of hyponatremia is low, NSAIDS are a risk factor for hyponatremia and altered kidney function in ironman triathlons.
The January 2007 issue of the Clinical Journal of Sport Medicine published a study by A.J. Page et al. which also concludes NSAIDs are a hyponatremia risk factor. They found that runners in a mountain ultramarathon who used NSAIDs or COXIBs to treat pain were more likely to develop hyponatremia.
There are also some studies that do not find a correlation between NSAID use and hyponatremia, so the question is not completely settled.
Marathon and ultramarathon runners should, however, seriously weigh the risks before deciding to take aspirin, ibuprofen, or other NSAIDs as pain medication during long endurance runs.
Ultrarunners are the Klingons of the athletic universe, and good Klingons never let a little pain stop them.
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