Pain Relievers

mjstaplesmjstaples Atlanta, GA, USMember
edited November 2013 in Beginner Questions
My last few long swims I have incorporated a couple advil at about 3 hrs in and then again 4 hrs later. Can't really say I could tell a significant difference. What are your thoughts on using pain relievers during swims. Do they really make a difference? Does anyone use liquid products (such as children's liquid advil) and if so what dosages do you take?

Comments

  • IronMikeIronMike Bishkek, KyrgyzstanCharter Member
    @mjstaples, during Swim the Suck 2012, I took a bottle of Crystal Light with a serving (?) of Children's advil in it at the 2 hour mark. It helped with the shoulders. I've not used pain relievers other than that time.
  • ssthomasssthomas Charter Member
    I use liquid infants Advil. I wait until it hurts and then start using it regularly, about 1 dropper/1.25 ML /50 Mg every 1.5 hours. Depending how hard I'm swimming, I can usually go 6-8 hours before I need it. It makes a huge difference to me. I never use it for training purposes.
  • david_barradavid_barra Charter Member
    The observer on an EC attempt that I crewed for took extensive notes on everything that was consumed by our swimmer. Ibuprofin was part of the feed plan, and great care was taken to insure that the dosage would not exceed the 24 hour maximum allowance for that product.

    I tried liquid ibu once... results: not good.

    I’ll stick to Hammer Nutrition Tissue Rejuvenator as my go to product before (daily) and during long swims.

    I’ll often take ibuprofin after.

    ...anything worth doing is worth overdoing.

  • IronMikeIronMike Bishkek, KyrgyzstanCharter Member
    @david_barra, thanks for the Hammer Nutrition Tissue Rejuvenator recommendation. I'd never heard of it. Although Glucosamine and Chondroitin never seem to work for me (tried them years ago for my knees), I'm willing to try something naturopathic.

    So how many do you take before a long swim? Their website says "1 capsule every 2-3 hours has been successfully used during ultra marathon races as an alternative to NSAIDS." Is that what you take?
  • david_barradavid_barra Charter Member
    IronMike said:


    So how many do you take before a long swim? Their website says "1 capsule every 2-3 hours has been successfully used during ultra marathon races as an alternative to NSAIDS." Is that what you take?

    i take 2 every morning. during long swims... 1 every 2 hours. post long swims... 4in the morning for a few days.

    ...anything worth doing is worth overdoing.

  • david_barradavid_barra Charter Member
    Keep in mind... ibuprofin and Hammer’s Tissue Rejuvenator are anti-inflammatories and will only relieve pain when inflamation is the cause.
    I am not a doctor... nor do I play one on TV.

    ...anything worth doing is worth overdoing.

  • Lots of people say that advil and other nsaids shouldn't be used in endurance events because they present an acute risk to your kidneys; they slow down your kidney function.

    Tylenol is said to be a better choice because while tylenol in high doses can be an issue for your liver with long term use, it apparently wouldn't be an issue with taking it on a given single day.

    Also not a Dr., do not play one on TV, and I'm not as handsome as Mark Harmon either.
    dpm50
  • evmoevmo San FranciscoAdmin
    @Kevin_in_MD - are there references for this, other than word of mouth?
  • I would avoid Tylenol during endurance events. Ibuprofen during or Aleve preceding would be by suggestion. Pretty indifferent on low levels of aspirin before or during. Shouldn't be too much of an issue as long as blood pressure while swimming isn't affected.
  • ssthomasssthomas Charter Member
    In preparing for Tahoe, I spoke with a doctor about use of pain relievers. He recommended ibuprofen over Tylenol. He said as long as I don't have pre-known issues with my kidneys and stay below the daily recommended allowance, I should be fine. I asked a lot of questions about the consequences of being dehydrated and taking lots of ibuprofen, whether or not it’s possible to build your tolerance to allow yourself to take more than the daily amount, and a few other things that I don’t remember any more. But, what I got from our conversation is that if you stay below the daily recommended amount of ibuprofen, your kidneys shouldn’t have issues.
  • malinakamalinaka Seattle, WACharter Member
    My take on this has been that if something hurts, fix it. My left shoulder pain is a regular reminder of everything my physical therapist told me to work on, and a constant reminder to check my stroke technique, and a constant reminder that if I don't fix the cause, my left shoulder might not last through the end of this century. If something is inflaming, especially unilaterally, get it looked at. Save your box of tricks for when you really need them, somewhere past the fifth hour I'd imagine.

    @kevin_in_md, some would say endurance events themselves cause kidney damage (cited: NIH via PubMed and a friend who's a doctor). Analgesics are referenced, but so are other contributing factors.

    I don't wear a wetsuit; it gives the ocean a sporting chance.

  • http://www.active.com/articles/ibuprofen-for-training-and-racing

    http://sportsmedicine.about.com/od/medicationanddrugs/a/NSAID_endurance.htm

    http://latino.foxnews.com/latino/health/2012/02/28/marta-montenegro-tylenol-or-advil-or-neither/

    All of those point to studies on nsaids in endurance exercise and the risk for one's kidneys.

    The tylenol was suggested to me personally by a nephrologist triathlete acquaintance of mine. I don't think there are any studies showing differences between the medicines, in fact last one I looked at specifically mentioned they excluded people who took tylenol (paracetamol).
  • I agree with Malinaka, save your box of tricks for the end of the swim, when you really start to hurt. Also, after doing extensive research (I am not a dr nor do I play one on TV) I am a huge fan of Pycnogenol as an anti-inflammatory. It does not have the side affects of NSAID's….
  • JSwimJSwim mtn MarylandMember

    Anyone used Anica gel for soreness? It's a natural anti-inflammatory made from plants in the sunflower family.

    I went to my USM practice yesterday, the day after a 10K (Swim to the Moon in Michigan), and kicked/sculled the whole time because my shoulders hurt so much. Ibuprofen hadn't helped much at all. Another swimmer recommended Anica gel. I'd never heard of it... But now I'm a convert.

    Rubbed it on twice over 2-3 hours and then my shoulders felt almost normal. Couldn't believe it!

    I got Boiron brand Anicare Gel. There are tablets available. Anyone tried those, especially before a swim?

    Life begins at the end of your comfort zone. --Neale Donald Walsch

  • @JSwim Arnica is homeopathic. Therefore any effect is placebo. As comedian Dara O'Brian says about about alternative medicine: "if alternative medicine worked, it would just be called .... medicine".

    NiekSpacemanspiff
  • JSwimJSwim mtn MarylandMember
    edited August 25

    @loneswimmer I agree about homeopathy. But from what I can find about the gel, even though it is labelled "Homeopathic Medicine", it appears it isn't really. It has measurable amounts of the active ingredient. Some of the tablets seem to be another story.

    JenA

    Life begins at the end of your comfort zone. --Neale Donald Walsch

  • dpm50dpm50 PA, U.S.Member

    I'm not a doctor and I'm only doing my first marathon swim coming up 9/4, so FWIW....

    I'm allergic to NSAIDs (i.e. wheezing, rashes). I've taken tylenol before long swims (I mean not in your ballpark long but 5+ miles), and it's been okay but after a while my shoulders start to protest even so.

    So I'm interested in the other products mentioned--I tend to get foot cramps, so that can be an issue too--never got them so I couldn't swim, but still they're a nuisance I'd like to prevent. I think what Tylenol did was to make them bearable and more temporary than they might otherwise have been.

  • JSwimJSwim mtn MarylandMember

    The little bit I've research on the web about Anica leaves me kind of confused. It appears to be in homeopathic and non homeopathic products. It can have side effects, especially if taken internally. And if someone is allergic to ragweed, marigolds etc it can cause an allergic reaction. I was really hoping someone here was already using it and knew which brands had measurable amounts, especially for the tablets. I'd like to try taking it before a long swim.

    Life begins at the end of your comfort zone. --Neale Donald Walsch

  • There's this gem at the end of the link I included above:

    "Although it seemed like the perfect remedy to “prove” that homeopathy works to our critics, Arnica has not yet proved its effectiveness in clinical trials. It could be that poor trial design is to blame because the results go against everything that 200 years of homeopathic practice tell us. However opponents of homeopathy have used this as a stick to beat us. But Arnica is Arnica. It has shown its constitutional picture as the victim of the bullies. Its reputation has been bruised, battered by the sceptics. The “it can’t work, so it does not work” approach to homeo­pathy has led to a bruised, battered homeopathic community. But Arnica is a daisy – it will bounce back, as will homeopathy."

  • JSwimJSwim mtn MarylandMember
    edited August 25

    Thanks @loneswimmer! I hadn't clicked on that link. That clarified the issue. I'm interested in "herbal" arnica, not "homeopathic" arnica.

    Life begins at the end of your comfort zone. --Neale Donald Walsch

  • wendyv34wendyv34 Vashon, WAMember

    dpm50- Have you tried taking magnesium the evening before a swim? I tend to cramp frequently and magnesium has done the trick for me. I just take one (250mg).

    dpm50

    It's always a bad hair day when you work at a pool.

  • dpm50dpm50 PA, U.S.Member

    Thanks for the suggestion, Wendy! I'll give that a try

  • JenAJenA Member

    Because Tylenol (aka acetaminophen, paracetamol) work as fever reducers, I believe there's a chance that they could lower body temperature. We know some swimmers develop elevated temperatures before or during swims... It's possible that Tylenol may work to lower your core temp.

  • MvGMvG NetherlandsMember

    Ibuprofen and paracetamol for me, especially to sooth tendonitis in shoulders and lower back pain. My body seems to be adapting somewhat as I use less pain relief nowadays than a couple of years ago. But doing a 30+k swim without any pain relief would be a tall order for me.

    I wonder where we draw the line. Did Captain Webb use pain relief? We seem to consider swims using over-the-counter anti-inflammatory medicine ok, but what if heavier (opioid etc.) medicine were to be used?

    Where does pain relief end and doping start? @evmo, @loneswimmer, do MSF rules clarify this?

    loneswimmer
  • NoelFigartNoelFigart Lebanon, NHMember

    MvG said: Did Captain Webb use pain relief?

    I am not sure how good the fact-checking was on this site, but it seems he used brandy. Which I think is kinda considered a no-no in our modern times just because of the dangers of vasodilation and hypothermia.

    http://www.history.com/this-day-in-history/captain-webb-swims-english-channel

    MvGLeadhyena
  • dpm50dpm50 PA, U.S.Member
    edited August 25

    I wouldn't want to use opiate drugs for swimming. They'd put me to sleep. Sleeping is incompatible with continuing to swim, just this newbie's guess. :)

    MvGNoelFigartJSwim
  • @MvG, for now MSF rules are that we guided by the WADA list. We don't have the resources to tackle anything more but I'd be all for specific guidelines if I thought we could write them.

    But if you remember this thread, you'll know that we are interested in understanding more about what might occur in performance enhancing substance use, where people might be using PEDs like EPO or otherwise. Then there's @jcmalick's & @evmo's thread on caffeine, which if we didn't all overdo it for swims, wouldn't have caused the panic it did when I pulled that April's Fools that caffeine had been banned.

    If you look at something like the Dover or Sandycove 6 hour mass qualifiers, you'll see people taking about, recommending and even swapping pain killers (I've done this) , and prophylactic use of over-the-counter aspirin, paracetamol and 'bufen is common. I know the CS&PF Observers track pain killer use during an EC swim, and I've done it when acting as either crew or observer on other swims. Have never personally seen a situation thought where people were over (or close) to the limit.

    I did have a conversation with a medical professional, I can't recall his specialty right now this year, who was also a marathon runner. I'd just hiked up Glendalough and taken this, (gratuituous use of unrelated photography):

    https://www.flickr.com/photos/loneswimmer/16425802739/sizes/l

    He was greatly concerned about the use of systemic painkillers in endurance athletes and recommended that we should instead be using more topical painkillers (like Voltarol Emugel here in Ireland & UK, active ingredient diclofenac diethylammonium, no idea what the US equivalent is, but then you all keep quoting US pharma products anyway). He said that systemic painkillers as used copiously by people like us, were more likely to have a cumulative negative effect on organs that weren't in difficulty. It's make superficial sense, but I don't have the background to evaluate that, though I had planned to do some research reading on the subject with a view to writing an article.

    We had plenty of legal people here who are swimmers, would any of our medical professional people be able to comment?

    MvGJSwim
  • JenA said: Because Tylenol (aka acetaminophen, paracetamol) work as fever reducers, I believe there's a chance that they could lower body temperature. We know some swimmers develop elevated temperatures before or during swims... It's possible that Tylenol may work to lower your core temp.

    Tylenol (also aspirin and ibuprofen) only lower your body temperature if the elevated temperature is due to fever, by affecting the fever process. Fun fact, in the case of acetaminophen nobody knows how it does it.

    JenA
  • JenAJenA Member

    Wow, really, @danswims?!! That's truly incredible. Thanks for the heads up!

  • JenAJenA Member

    For those who want to know more:

    Acute acetaminophen ingestion does not alter core temperature or sweating during exercise in hot-humid conditions.

    http://www.ncbi.nlm.nih.gov/m/pubmed/25943660/?i=5&from=tylenol hyperthermia

  • @loneswimmer, I'm not an MD but did study pharmacology and get to put Dr in front of my name. All of the over the counter pain medications have risks. The biggies are for aspirin, bleeding (including stroke) and ulcers; Ibuprofen, ulcers and liver damage; acetaminophen/paracetamol, liver damage. Risks go up with increasing dose and increasing duration of taking a drug.

    Reading the posted comments about what people are using during their swims I've never seen anything that seemed excessive in terms of dosage. Using something before and during long swim events would carry pretty low risk of problems. The exception to that is if you drink alcohol with regularity I would avoid acetaminophen/paracetamol.

    I suspect your medical professional was more concerned with chronic day in and day out use. I've heard ibuprofen referred to as vitamin I. Wake up sore from yesterday's workout, take a couple. Take a couple more before and then a couple more after today's workout. Maybe a couple more before going to bed. Repeat indefinitely is a recipe for problems.

    Voltarol Emugel (Voltaren in the US) sounds interesting. Wouldn't be very useful during a swim though.

    JenAloneswimmerIronMike
  • IronMikeIronMike Bishkek, KyrgyzstanCharter Member

    @danswims, you say to "avoid acetaminophen/paracetamol" if you drink alcohol regularly. I assume because of liver damage, as you have listed in your first paragraph.

    But you also have liver damage next to Ibuprofen. Should we avoid that too if we, um, drink regularly?

    Not saying that I have an alcohol problem, but how else am I going to empty these beer bottles so I can fill them with more homebrew?

    JenAmjstaplesdpm50
  • IronMike said: @danswims, you say to "avoid acetaminophen/paracetamol" if you drink alcohol regularly. I assume because of liver damage, as you have listed in your first paragraph.

    But you also have liver damage next to Ibuprofen. Should we avoid that too if we, um, drink regularly?

    Not saying that I have an alcohol problem, but how else am I going to empty these beer bottles so I can fill them with more homebrew?

    The risk of serious liver damage with even moderate dosing of acetaminophen/paracetamol plus alcohol use is high enough that it is probably best to avoid acetaminophen/paracetamol if you choose to drink. If you don't have existing liver issues ibuprofen is less problematic, particularly in the intermittment short term use scenario of swim events. Chronic use of ibuprofen or other NSAIDs or prexexisting liver problems is another matter entierly, please talk to your MD. There appears to be a acetomenopin + aclchol = bad news situation that I as a regular wine drinker choose to not use acetaminophen/paracetamol as I have other, safer choices.

    IronMike
  • IronMikeIronMike Bishkek, KyrgyzstanCharter Member
  • I schedule ibuprofen into my feed plan - beginning at hour 3, and then every 3 hours. Children's version so it is liquid and easy to mix into my feeds - swallowing tablets at sea is very very tricky. I asked the pharmacist what dose to take for adults.

    I take codeine as needs be for injury or further pain management.

    I also have some caffeine.

    I have magnesium as needs be for cramping... and pickle juice if the magnesium doesn't work.

  • dpm50dpm50 PA, U.S.Member

    Not good news for me, as acetaminophen is my go-to ever since I became allergic to NSAIDs. However for the past 20 years, I've used it and drink wine/beer and have never had an issue. I do space the two apart. Typically, my running and swimming events are in the morning; I'll have wine or beer in the evening with dinner. So there's some gap between taking the med and having the drink. I wonder, though, if there's quiet damage being done that will show up in time. Hope not!

    danswims said:

    IronMike said: @danswims, you say to "avoid acetaminophen/paracetamol" if you drink alcohol regularly. I assume because of liver damage, as you have listed in your first paragraph.

    But you also have liver damage next to Ibuprofen. Should we avoid that too if we, um, drink regularly?

    Not saying that I have an alcohol problem, but how else am I going to empty these beer bottles so I can fill them with more homebrew?

    The risk of serious liver damage with even moderate dosing of acetaminophen/paracetamol plus alcohol use is high enough that it is probably best to avoid acetaminophen/paracetamol if you choose to drink. If you don't have existing liver issues ibuprofen is less problematic, particularly in the intermittment short term use scenario of swim events. Chronic use of ibuprofen or other NSAIDs or prexexisting liver problems is another matter entierly, please talk to your MD. There appears to be a acetomenopin + aclchol = bad news situation that I as a regular wine drinker choose to not use acetaminophen/paracetamol as I have other, safer choices.

  • @dpm50, obviously a lot of people use both alcohol and acetaminophen and the vast majority of them have no problems. The more of either you use the higher the risk. Definitely don't use more acetaminophen at one time than the label says and don't go over 4000 mg a day (some sources say 3250 mg max per day.) The safe dosage range is a pretty narrow window. If you are using both regularly that annual physical might not be a bad idea. Some of the bloodwork they do looks at liver function.

    Taking the two at different times of they day doesn't help. Chronic alcohol use, especially heavy use, increases the liver enzyme that converts acetaminophen into a toxic metabolite which is what whacks the liver. It may seem strange but taking acetaminophen and alcohol at the same time actually protects the liver from damage. While alcohol is in the system this breakdown into a toxic metabolite is suppressed.

  • @loneswimmer, update on Voltarol/Voltaren. Unfortunately it doesn't work. Asked a rheumatologist swim buddy about these topical non steroidal anti-inflammatories. Manufacturers claim they penetrate the skin and stay in the local area where applied. Follow up studies are not supporting this claim.

    loneswimmer
  • dpm50dpm50 PA, U.S.Member

    Thanks for the feedback on this, @danswims -- good points to remember, as typically I don't get liver function tests. Interesting about its being better actually to take the alcohol and acetaminophen at the same time. I was spacing them apart thinking that offered more protection (and quite honestly, I address different needs when taking the one than the other). I usually don't have more than a glass of beer or wine w/ dinner--with the exception of celebrations/parties--and I don't take the med on a regular basis, just when I'm in a race or longer workout (for run-of-the-mill masters' practice, I never need it, and even for most short events). I've come to favor the 8 hour extended release form, which may or may not be the best choice.

    Thanks for the heads-up.

    I'd love to find something that's non-(or mostly non-)allergenic for me but that works as well as NSAIDs. Used to be able to take the NSAIDs w/ no problem, but then began developing allergic responses (welts and wheezing) that stopped once I stopped taking them.

    danswims said: @dpm50, obviously a lot of people use both alcohol and acetaminophen and the vast majority of them have no problems. The more of either you use the higher the risk. Definitely don't use more acetaminophen at one time than the label says and don't go over 4000 mg a day (some sources say 3250 mg max per day.) The safe dosage range is a pretty narrow window. If you are using both regularly that annual physical might not be a bad idea. Some of the bloodwork they do looks at liver function.

    Taking the two at different times of they day doesn't help. Chronic alcohol use, especially heavy use, increases the liver enzyme that converts acetaminophen into a toxic metabolite which is what whacks the liver. It may seem strange but taking acetaminophen and alcohol at the same time actually protects the liver from damage. While alcohol is in the system this breakdown into a toxic metabolite is suppressed.

  • danswimsdanswims Member

    @dpm50, pretty unlikely you'd have any issues at that level of use. Do you also react to aspirin? That's about the only other choice.

  • dpm50dpm50 PA, U.S.Member

    After my first couple allergic reactions (you might think I'd learn after just one but at first they were mild and I chalked them up to other causes until I had one I couldn't ignore), my Dr said I was to avoid aspirin and all NSAIDs. Now I don't really miss them.

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