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Management of Pain in Elite Athletes

Identified Gaps in Knowledge and Future Research Directions

Zideman, David A., LVO, BSc, MBBS, FRCA, FRCP, FIMC*; Derman, Wayne, MBChB, PhD†,‡; Hainline, Brian, MD§; Moseley, G. Lorimer, DSc, PhD, BPhty(Hons), FAAHMS, FACP; Orchard, John, MD, PhD, FACSEP, FACSM**; Pluim, Babette M., MD, PhD, MPH††; Siebert, Christian H., MD; Turner, Judith A., PhD‡‡

Clinical Journal of Sport Medicine: September 2018 - Volume 28 - Issue 5 - p 485–489
doi: 10.1097/JSM.0000000000000618
General Review
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Objective: For elite athletes to train and compete at peak performance levels, it is necessary to manage their pain efficiently and effectively. A recent consensus meeting on the management of pain in elite athletes concluded that there are many gaps in the current knowledge and that further information and research is required. This article presents the crystallization of these acknowledged gaps in knowledge.

Data sources: Information was gathered from a wide variety of published scientific sources that were reviewed at the consensus meeting and the gaps in knowledge identified.

Main Results: Gaps have been identified in the epidemiology of analgesic use, the management of pain associated with minor injuries, and the field of play management of pain for athletes with major injuries. From a pharmacological perspective, there is a lack of information on the prescribing of opioid medications in elite athletes and more data are required on the use of local anesthetics injections, corticosteroids, and nonsteroidal anti-inflammatory drugs during training and in competition. Pain management strategies for the general population are widely available, but there are few for the elite sporting population and virtually none for elite athletes with a disability. More research is also needed in assessing cognitive-behavior therapies in improving specific outcomes and also into the new process of psychologically informed physiotherapy. A key issue is the paucity of data relating to incidence or prevalence of persistent pain and how this relates to persistent dysfunction, exercise performance, and physiological function in later life.

Conclusions: The identification of the gaps in knowledge in the management of pain in elite athletes will provide a unified direction for the retrieval of information and further research that will provide reassurance, speed return to active sport, and benefit performance.

*Medical & Scientific Department, International Olympic Committee Medical and Scientific Games Group, Lausanne, Switzerland;

Department of Surgical Sciences, Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa;

Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Science Stellenbosch University, IOC Research Center, South Africa;

§National Collegiate Athletic Association (NCAA), Clinical Professor of Neurology, Indiana University School of Medicine, Indianapolis, Indiana;

School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia;

**Medical Department, Koninklijke Nederlandse Lawn Tennis Bond (KNLTB), Amersfoort, The Netherlands;

††Hanover Medical School, Hanover, Germany;

School of Public Health, University of Sydney, Australia; and

‡‡Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.

Corresponding Author: David A Zideman, Medical & Scientific Department, International Olympic Committee, Chateau de Vidy, 1007 Lausanne, Switzerland;david.zideman@gmail.com.

The authors report no conflicts of interest.

Received March 15, 2018

Accepted May 01, 2018

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