In Reply

Letters to the Editor Analgesic Use in Sports Results of a Systematic Literature Review by Prof. Dr. med. Dr. Sportwiss. Dieter Leyk, Dr. Sportwiss. Thomas Rüther, Nadine Hartmann, Dr. med. Emanuel Vits, Dr. rer. nat. Markus Staudt, and PD Dr. med. habil. Manuela Andrea Hoffmann in issue 10/2023

The survey data reported by Gnutzmann and Weisser and their conclusions are plausible. Longitudinal analyses of painkiller use in society as a whole show that women tend to use pain medication more frequently than men (1). It is quite reasonable to assume that female athletes are also more likely to self-medicate without medical supervision (and with inadequate knowledge). Beyond this gender aspect, the data from Kiel are valuable because they are mainly drawn from amateur sports (almost 80%) and indicate a widespread use of analgesics (now also) in recreational and popular sports. Similarly, other feedback to our article suggests that the painkiller problem has worsened in recent years and was underestimated during the public hearing in the German Bundestag (2). Non-indicated pain medication is also thought to be used to “maximize” vacation days (e.g., while skiing, surfing or cycling). In subclass game sports, there are reportedly “pill guards” who hand out painkillers to active players before a game.

However, reliable representative data are so far lacking in this gray zone. Currently, the extent of the problem cannot be determined by literature searches in listed journals. The nationwide ActIv project with now almost 20 000 participants (www.dshs-koeln.de/activ) surveys both athletic and non-athletic participants about which painkillers (active ingredient), for what reasons and how often they are taking, whether side effects and dosages are known, and by whom the use of pain medication was recommended. These data, together with other study results (e.g., from the Kiel study or from the ongoing DFB and DFL painkiller study), will hopefully lead to health political action (e.g. advertising restrictions, better and more addressee-appropriate education) in order to reduce the harmful use of painkillers in sports and in the society as a whole (3, 4).

DOI: 10.3238/arztebl.m2023.0126

Prof. Dr. med. Dr. Sportwiss. Dieter Leyk
Deutsche Sporthochschule Köln, Forschungsgruppe Leistungsepidemiologie, Universität Koblenz, Fachbereich Informatik, Koblenz, Germany

Dr. med. Emanuel Vits
Deutsche Sporthochschule Köln, Forschungsgruppe Leistungsepidemiologie, BundeswehrZentralkrankenhaus Koblenz, Klinik X Anästhesiologie, Intensiv-, Schmerz- und Notfallmedizin, Koblenz, Germany

Conflict of interest
EVs holds shares in Sanofi S. A. and in the Zur Rose Group AG.
DL declares no conflict of interests.

References

1. Seitz NN, Lochbühler K, Atzendorf J, Rauschert C, Pfeiffer-Gerschel T, Kraus L: Trends in substance use and related disorders—analysis of the Epidemiological Survey of Substance Abuse 1995 to 2018. Dtsch Arztebl Int 2019; 116: 585–91

2. Deutscher Bundestag: Schmerzmittelkonsum im Sport und in der Gesellschaft. Anhörung während der 63. Sitzung des Sportausschusses am 27.01.2021 14:00 Uhr. www.bundestag.de/webarchiv/Ausschuesse/ausschuesse19/a05_Sport/anhoerungen/797912-797912 (alst accessed on 15 May 2023).

3. Heinz A, Liu S: Addiction to legal drugs and medicines in Germany. Dtsch Arztebl Int 2019; 116: 575–6

4. Leyk D, Rüther T, Hartmann N, Vits E, Staudt M, Hoffmann MA: Analgesic use in sports—results of a systematic literature review. Dtsch Arztebl Int 2023; 120: 155–61