Massage therapy is a growing presence at sporting events, offered both pre- and post-event, primarily for increased flexibility and pain relief, respectively.

New research indicates competitive athletes who opt for pain medication suffer from increased pain and gastrointestinal distress than do athletes who refrain from taking pain medication.

The research was conducted among competitors in the Bonn Marathon, via online questionnaire.

“Withdrawal from competition because of gastrointestinal problems was significantly more common among those taking painkillers,” the researchers said.

Over half the drugs—54 percent—were bought over the counter without a prescription, and included diclofenac, asprin and ibuprofen, the researchers noted.

Other symptoms among the pain-medication-taking athletes included stomach cramps, cardiovascular problems, gastrointestinal bleeds, blood in the urine and joint and muscle pain, according to a press release. Muscle cramps were significantly more common in those who had taken these drugs.

“Virtually none of the respondents said they were aware of any risks associated with taking painkillers for endurance sports,” the press released noted, yet, “nine runners who took painkillers said they had ended up in a hospital: three for temporary kidney failure after taking ibuprofen; four for bleeding ulcers (aspirin), and two after a heart attack (aspirin), one of whom had taken 500 mg for mild foot pain.”

None of the runners who competed without having taken painkillers was admitted to a hospital.

Painkillers block enzymes called cyclooxygenases, which regulate the production of prostaglandins. But the authors suggest that prostaglandins also protect tissues when the body is under extreme stress, such as during endurance sports according to the press release.

“Taken together, our data indicate that the widespread use of cyclooxygenase inhibitors in connection with endurance sports is potentially damaging. Further investigations are warranted to examine whether the use of analgesics before and during sports activities should be avoided altogether,” the researchers concluded.

“Painkillers taken before marathons linked to potentially serious side effects” was conducted by investigators with Pain Management Center DGS, in Bonn, Bad-Godesberg, Germany; and the Department of Experimental and Clinical Pharmacology and Toxicology, in FAU Erlangen-Nuremberg, Erlangen, Germany; it was published in the online journal BMJ Open.