Pain Medications and Exercise

Millions of people struggle with the problem of chronic pain (defined as pain lasting longer than three to six months). The severity and frequency of the pain can range from mild, occasional discomfort (such as a typical headache) to intense, constant pain. Whether pain is something you deal with on a daily basis or infrequently, you don't want those symptoms to derail a consistent exercise program.

Pain is a complicated problem because the symptoms, causes, frequency and treatments vary greatly from person to person. The most common sources of chronic pain include headaches, backaches, joint pain (such as knees and hips) and pain from specific injuries. Depending on the severity and frequency of the problem, it can change a person's entire life. Not only does pain take a physical toll on the body, it also takes an emotional toll. For example, depression is the emotion most commonly associated with back pain.

Often, certain exercises can help you feel better and decrease your symptoms. But when you need to take medication (either prescription or over-the-counter) to deal with the pain, is it still safe to exercise? Are there any special concerns before, during or after your workout to keep you healthy?

Common Pain Medications
Getting pain under control can be achieved through a variety of techniques, including medication. Physicians often start with over-the-counter (OTC) medicines that have fewer side effects, and then will progress to stronger prescription drugs if necessary. Here are some of the common side effects associated with pain medications, and how you should adjust your exercise program accordingly:

Acetaminophen is a common ingredient found in more than 600 prescription and OTC medications, the most well-known being Tylenol. It's generally safe to take before or after exercise when taking according to instructions. Because it's found in so many different products, and there are serious side effects from taking too much, always read labels if you're taking more than one type of medication.
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve minor aches and pains and include ibuprofen (Advil), naproxen (Aleve) and aspirin. These products also come in prescription strength dosages. Taken before exercise, they can mask the pain of muscle soreness (which may lead to an increased risk of injury), but they don't actually help prevent muscle fiber damage, like some people believe. Endurance athletes have been warned against taking NSAIDs before athletic events (such as a marathon) because of studies that suggest it could increase the risk of hypernatremia (elevated sodium levels in the blood), which can lead to sudden death. These medications should be reserved for moderate use only after intense exercise. NSAIDs can also upset an empty stomach, so always take them with food. Also make sure you're drinking enough water, as they increase the risk of dehydration.
Opioids are powerful drugs that change the way a person experiences pain. Morphine, oxycodone and codeine are all examples of opioids. After taking opioid pain medication for an extended period of time, patients can develop a tolerance for the drug, meaning they need higher doses of it to achieve the same effect in reducing pain. Anyone taking opioids should be closely monitored by their doctor. The use of opioids can lead to drowsiness, so be aware of this side effect when exercising. Opioids can also lower blood pressure, which increases the risk of orthostatic hypotension (a form of low blood pressure), which can lead to additional complications. Be especially careful when getting up from a lying or sitting position, as it can cause dizziness or fainting if done too quickly.
Sports creams like BenGay, Icy Hot and Tiger Balm can be effective at reducing muscle pain and aren’t commonly thought of as medication. However, it is possible to overdose on their active ingredient methyl salicylate, which provides their wintergreen scent. In 2007, a teenage runner died after applying multiple products containing the ingredient, which was absorbed through her skin. Always follow the label directions, including not to use the product for more than 7 days in a row and not to use it on children younger than 12.

All medications have side effects, some more significant than others. It's important to take all medications as directed, and keep your doctor informed if you're experiencing any negative effects. Keep in mind that individuals taking the same medication may have very different responses to it.

Exercise itself can be a good tool for pain management. When you exercise, the body produces endorphins which are natural chemicals that inhibit pain signals to the brain. It's important to work closely with your doctor to create a progressive exercise program that helps deal with the pain instead of leaving you feeling worse because you pushed yourself too hard. When you do have to take medication to relieve pain symptoms, have a good understanding how it works and how it can affect your body. Your local pharmacist can be a great resource if you have questions about your medications.

This article has been reviewed and approved by Nicole Nichols, certified personal trainer.

Sources
American Chronic Pain Association. "ACPA Resource Guide to Chronic Pain Management and Treatment," (PDF) accessed April 2, 2013. www.theacpa.org.

Associated Press. “Sports Cream Warnings Urged After Teen’s Death,” accessed April 2, 2013. www.nbcnews.com

FDA Consumer Health Information. "A Guide to Safe Use of Pain Medicine," accessed April 2, 2013. www.fda.gov/consumer.

WedMD. "Chronic Pain Management," accessed April 2, 2013. www.webMD.com.

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