Should I Take a Pain Reliever Before or During a Marathon?

Marathon Runners
Marathon Runners. Cameron Spencer/Getty Imagrd nred

Marathon runners and walkers often want to take pain relievers before or during a marathon. You may wake up on race morning with a headache, muscle aches, or arthritis pain. Or, you may want to take a medication when you start feeling pain during the marathon or because you think it will prevent pain after you finish. Which pain relievers are the safest to take, or should you avoid taking any of them?

It is Best to Avoid Pain Relievers Before and During the Marathon

Unfortunately, pain relievers can cause problems during the marathon. A study of almost 4,000 marathon runners found more five times more adverse effects during the race among those who took over-the-counter pain relievers before the race. The most common problem was gastrointestinal upset. The expert physician panel at the Marathon Directors College also advised avoiding pain relievers before and during a marathon.

If you regularly take pain relievers for a condition, discuss using them on long training runs and walks and in marathon conditions with your doctor. She may have advice on how and when to use them.

Problems with NSAIDs

The most common over-the-counter non-steroidal anti-inflammatory medications are ibuprofen (Advil) and naproxen sodium (Aleve). They have two effects: pain relief and prevention of inflammation. They can cause nausea and they decrease kidney perfusion.

In the marathon study, five racers who took ibuprofen reported they were hospitalized with temporary kidney failure.

If you plan to use these drugs before or during the marathon, you should use them on your longest training runs or walks to see if can tolerate them and whether they have ill effects on you.

While you may not usually have problems with NSAIDs, you are putting your body under extreme conditions for 26.2 miles and you may have an unexpected reaction.

Problems with Acetaminophen (Tylenol)

Acetaminophen has two effects: pain relief and fever reduction. It can be toxic to the liver when you are overheated and at oxidative stress, as when running or walking a marathon, making it especially concerning for use when you are going to be logging long miles. Some people get nausea from acetaminophen, which is already a common complaint of marathoners.

Your liver takes most of the work of breaking down acetaminophen, and the difference between a therapeutic dose and toxic dose has a narrower range than for the NSAIDs. If you lose track of how much you are taking, you can damage your liver permanently, and an overdose is not treatable.

Problems with Aspirin

Aspirin has two effects: pain relief and fever reduction. It also inhibits the ability of the blood to clot effectively in most people. This can result in bleeding more if you have an injury, and experts suspect you have more micro-bleeding and burst capillaries from the 26.2 miles of pounding your feet and legs take during a marathon.

Many people experience nausea and even gastric bleeding from aspirin. In the large marathon study, four racers who took aspirin reported being hospitalized with bleeds and two with cardiac infarctions.

Many people take low-dose aspirin regularly as recommended by their doctor. You will know how that affects you on your long training runs.

Beer

Alcohol during a run is not advised, especially if you have taken any other pain medication. You may pass some informal stops near the end of the race with groups offering beer. It's best to pass them by and wait until you have recovered at home with appropriate fluids until you enjoy a celebratory beer.

While presented with humor, the Marathon Directors' College medical panel noted that beer provided hydration, carbohydrates, salts, and pain relief when taken during the marathon. In fact, one of the physician's prescribed it as a quick remedy for muscle cramps. Portland Marathon Race Director Les Smith once experimented with beer as his sole hydration during a marathon and the results were "When I finished, I was looped." It was noted that beer decreases athletic performance, "It was a slow marathon."

Try Nothing New on Race Day

It is best to avoid pain relievers before or during the marathon. Use your long training days to experiment with how you feel running or walking without any pain relief, and what effects you have if you resort to using pain relievers. As always, try nothing new on race day.

Sources:

Küster M, Renner B, Oppel P, Niederweis U, Brune K. Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study. BMJ Open. 2013 Apr 19;3(4). pii: e002090. doi: 10.1136/bmjopen-2012-002090. Print 2013.

Marathon Directors' College. Meeting hall, Portland, Oregon, October 6, 2005.

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