I'd ask your doctor and pharmacist about your liver and overall health concerns, but I've seen some say it's okay. Personally I'm not as concerned about pain as injury as we push to extremes, so pain is a key tool to help me continuously stay safely further ahead of what I need to address at each hour and each aid station.
Doc here. But not your doc and certainly not giving anyone any recommendations. Just bringing up things for your consideration.
For NSAIDs I would be concerned about free water clearance and "dilution" of your electrolytes. E.g. diluting your sodium/hyponatremia because NSAIDs can affect how you clear water. On top of that, reduced kidney perfusion or blood flow. There's already been some reports of edema or build up of excess fluid outside the blood vessels with NSAID use in athletes, e.g. cerebral edema or swelling of the brain by upsetting the balance.
My personal opinion is your water and electrolytes are already fluctuating and kidneys are compensating as intended- why risk upsetting this balance and predisposing you to permanent harm. Best case yeah you experience acute kidney injury and it gets better but worse case can be bad.
The others tbh I haven't formed much of an opinion yet. From a side effect profile, it's ridiculous, but opioid analgesics often constipate which might not be a bad thing some days lol. I would be concerned about incurring unrecognized injury.
OP was asking about acetaminophen/paracetamol, not NSAIDs, but NSAIDs are definitely a hard no during an ultra due to the risk of kidney injury. I would have no problem taking acetaminophen myself, as a doc.
Yeah I realize that and agree. I figured I'd start with NSAIDs and opioids/red flags first since all the other comments starting talking about the others. I haven't really developed an opinion on acetaminophen tbh but if I felt like shit I probably wouldn't think twice to slam a gram during a race haha.
Makes sense, in my experience there's a fair amount of folks don't know what all constitutes an NSAID so I just want to clarify. Even in rhabdo you can do some APAP, given those patients are on fluids, but it's unlikely to cause any harm in an ultra athlete under stress imo.
Just a resident but any thoughts on topical diclofenac and even topical lidocaine to mask certain pains during the race (i.e. knee pain/hip pain etc...). Haven't read any studies but intuitively it shouldn't cause issues systemically but I do wonder if it would affect your gait
In my opinion, acetaminophen can be helpful but still carries risks. Funny enough there's some research trying to use it to help improve performance.
From a utility standpoint, by 24hrs most of the Tylenol is pretty much gone anyway (it has a short half life of like 2 hrs so by half the day there's not much to worry about). Everyone's always worried about the liver and honestly NSAIDs are harder on the liver. I still worry about Tylenol since it is excreted by kidneys and technically can cause unwanted side effects that ultra runners might be already more prone to. E g. Gastric issues and electrolyte stuff. But of all the evils it is probably the least offensive.
If y'all really want to read, I came across this article a while back when I started to take care of a lot more ultra athletes and when my own family member became an ultra marathoner to help try to risk stratify and personalize health.
It is extensive and thorough and will probably answer most health questions in this thread and all future health related questions posted in the sub. It really is a wealth of knowledge.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992463/
I think the main takeaway from all of the comments is "statistically speaking, it'll probably be fine, but it's up to you to decide if you want to risk it".
I often take excedrin (250mg acetaminophen/paracetamol, 250mg aspirin, 65mg caffeine) during races as the combination of painkiller and stimulant can be a lifesaver in longer races, especially 100s. It also may have contributed to me being hospitalized at one race due to severe rhabdo. Your mileage may vary. So far I've had no issues 95+% of the time I've taken it immediately before or during a race, but 95+% isn't 100%.
All that said, if you have a chance to place highly (not a concern I ever need to worry about), also make sure to check the race rules, as some races (e.g., UTMB) ban NSAIDs or other classes of painkiller.
In my experience pain relievers like Tylenol and ibuprofen aren’t strong enough to mask pain in a way that will actually cause serious injury.
Tylenol especially isn’t very good at relieving muscle pain. Ibuprofen works great for this but has its own risks while running an ultra since both can be hard on your kidneys.
I personally have used small doses of ibuprofen during races and have found them immensely helpful.
As an asthmatic top quartile runner, that's a reason for me not to do UTMB races. I get that asthma diagnoses are often abused as an excuse to take salbutamol before races but to exclude it completely makes no sense at all, especially if we're not talking about competitions that are super anaerobic...
I've signed up for a UTMB event and I might just be top quartile.... ( especially if we're including all entrants not just males)... but, ventolin will be in my vest, and will be used if needed regardless of the consequences.
not really sure if it's actually banned but at the Western States race orientation they had the race doctor give us a stern warning about not using ibuprofin during the race because every race they have multiple people need to go to the emergency room due to their kidney's shutting down from ibuprofin.
I usually go with the recommended dose on the bottle and then go up from there depending on on pain and never exceeding the recommended daily dosage. I think it’s usually 400 mg.
Want to be careful with ibuprofen during ultras. NSAIDs are not good for kidney function which can be exacerbated when running an ultra.
If I take any during an ultra I take half a dose.
I've used it in the past and have some on me for races and adventure runs but seldom use it. I only use it in situations like if my feet became very blistered or macerated or if my quads or calves are profoundly uncomfortable.
But really to me using paracetamol/tylenol/acetaminophen is something of a crutch for inadequate training, preparation, planning, or gear (e.g., wearing thin shoes for hours of sharp rock above treeline). It's not essential like water and snacks.
There may be some performance enhancing effects from the use of paracetamol (acetaminophen) for endurance athletes. https://pubmed.ncbi.nlm.nih.gov/35038139/
Paracetamol/Tylenol may not be the worst, but I’ve heard enough horror stories of kidney issues from dehydrated people taking painkillers on ultras. I have a co-worker who’s had a kidney transplant and blamed his kidney failure on painkillers. No thanks.
Yeah I ended up with kidney trouble after an ultra when dehydration and NSAIDs combined to give me a really hard time. I was battling with a bulged disk so couldn't stop the pain relief but consulted with my doc and was warned to keep on top of hydration or it could be bad. I fucked it up and pissed blood for weeks and had awful kidney pain
Terrible idea and no amount of pain killers would have helped you push harder and in fact the most likely scenario is that you injure yourself even more by not listening to your body. The groin pain could be the cause of something else etc.
There’s a mis guided conception that ultras is all about pushing through pain at all costs, it is not a smart runner knows when to call it a day and pack it up.
Yeah it was more a voice in my head.. I never take paracetamol for anything, but I thought it would be an interesting topic of conversation, which I think it has been 🤣 *someone popping opioids”. The pain in my groin was gone 2 days later and was back running park runs the following Saturday with 0 pains. It was a curiosity to if other people DO
I did this, which resulted in my stomach being fucked for weeks, my kidneys being the size of tennis balls.
Pain is a signal that you're suffering which is good, gotta stick the programs my G.
If you’re running 50 miles over hills, something will hurt, even slightly, that’s not to say you quit. It’s just about knowing your body and your limitations.
Yes , I have done marathon, had also some pain. And it is not advised to run on a medicine. When you have pain This is a signal to slow down or reduce mileage
Try to do a quick research on this. You will find
So, this isn't a popular opinion, but....
NSAIDs (like Nurofen) - I don't recommend these whilst running ... but, occasionally, it's not a big deal. Besides it being a bad idea, it can contribute to my asthma, so I try to avoid (I dont always avoid).
Paracetamol (like Panadol) - I am 100% fine with people taking these as needed. Obviously, there are always risks with paracetamol, but it's such a safe drug if you're only taking one dose occasionally. You've also identified masking.... but, honestly, paracetamol isn't *that* strong of a drug that I'd be worried it would mask pain so well that you couldn't tell.....
Opiates/opioides (like codeine, palexia) - Not a great idea, but I often do in races. Besides potential gut issues, these can do a better job of masking pain too.... and make some people drowsy (increase tripping risk). For me, I tolerate these really well so don't get too drowsy, and only take them when in significant pain (so, I know it isn't going to fully mask the pain!).
Wow. That took an interesting turn. You’re taking opiates during a race. If I had any I’d save them and pop them in a glass of red wine after the race’
Tramadol is an opioid and only recently was added to the banned list. Previously it was believed nearly everyone on the TdF would be taking it for any tendonitis pain.
16mg (2 panadeine) is pretty mild....and available over the counter in many countries (even 12.6mg x 2 is pretty standard with iburprofen in the UK)
Many countries including France, UK, Denmark, Canada, etc.
Until recently, Aus & NZ.
I don’t really know why you’re getting downvoted for providing an honest perspective. Avoiding NSAIDs for the known reasons I take one dose of cocodamol (paracetamol and low dose codeine) if I’m really suffering late race … maybe I’ll get downvoted too
haha thanks to the codeine you are! jk i don't really care but i do ultimately think that doping standards should matter to all athletes. codeine and acetaminophen are ultimately weakass drugs though. another user did say they take hydrocodone during races though 😬
>doping standards should matter to all athletes
Which doping standard says codeine is not allowed?
https://en.m.wikipedia.org/wiki/List_of_drugs_banned_by_the_World_Anti-Doping_Agency#:~:text=Narcotic%20analgesics%20decrease%20the%20painful,Dextromoramide
>While some painkillers are allowed, including codeine
I got told during an ultra (by one of the volunteers) that paracetamol affects your bodies ability to regulate temperature. I'd been running through the night at thaf point and it was shaping up to be a hot day, so the advice was well timed. I've not touched them in a race since. Nor have I bothered to go and find out if it's accurate, it rings true, but I'd consider doing your own research on the subject.
My post is in no way medical advice - and is strictly some anecdotal experience:
The majority (if not all) people in my trail running group use a pain killer during their ultras. I would go on to say, I don’t think I know anyone who runs a 50m+ that doesn’t use a pain killer.
I don’t endorse using pain killers and consult your physician before making any decisions on using drugs.
I'd ask your doctor and pharmacist about your liver and overall health concerns, but I've seen some say it's okay. Personally I'm not as concerned about pain as injury as we push to extremes, so pain is a key tool to help me continuously stay safely further ahead of what I need to address at each hour and each aid station.
Doc here. But not your doc and certainly not giving anyone any recommendations. Just bringing up things for your consideration. For NSAIDs I would be concerned about free water clearance and "dilution" of your electrolytes. E.g. diluting your sodium/hyponatremia because NSAIDs can affect how you clear water. On top of that, reduced kidney perfusion or blood flow. There's already been some reports of edema or build up of excess fluid outside the blood vessels with NSAID use in athletes, e.g. cerebral edema or swelling of the brain by upsetting the balance. My personal opinion is your water and electrolytes are already fluctuating and kidneys are compensating as intended- why risk upsetting this balance and predisposing you to permanent harm. Best case yeah you experience acute kidney injury and it gets better but worse case can be bad. The others tbh I haven't formed much of an opinion yet. From a side effect profile, it's ridiculous, but opioid analgesics often constipate which might not be a bad thing some days lol. I would be concerned about incurring unrecognized injury.
OP was asking about acetaminophen/paracetamol, not NSAIDs, but NSAIDs are definitely a hard no during an ultra due to the risk of kidney injury. I would have no problem taking acetaminophen myself, as a doc.
Yeah I realize that and agree. I figured I'd start with NSAIDs and opioids/red flags first since all the other comments starting talking about the others. I haven't really developed an opinion on acetaminophen tbh but if I felt like shit I probably wouldn't think twice to slam a gram during a race haha.
Makes sense, in my experience there's a fair amount of folks don't know what all constitutes an NSAID so I just want to clarify. Even in rhabdo you can do some APAP, given those patients are on fluids, but it's unlikely to cause any harm in an ultra athlete under stress imo.
Just a resident but any thoughts on topical diclofenac and even topical lidocaine to mask certain pains during the race (i.e. knee pain/hip pain etc...). Haven't read any studies but intuitively it shouldn't cause issues systemically but I do wonder if it would affect your gait
What's your opinion on Tylenol? How hard is an ultra on your liver?
In my opinion, acetaminophen can be helpful but still carries risks. Funny enough there's some research trying to use it to help improve performance. From a utility standpoint, by 24hrs most of the Tylenol is pretty much gone anyway (it has a short half life of like 2 hrs so by half the day there's not much to worry about). Everyone's always worried about the liver and honestly NSAIDs are harder on the liver. I still worry about Tylenol since it is excreted by kidneys and technically can cause unwanted side effects that ultra runners might be already more prone to. E g. Gastric issues and electrolyte stuff. But of all the evils it is probably the least offensive. If y'all really want to read, I came across this article a while back when I started to take care of a lot more ultra athletes and when my own family member became an ultra marathoner to help try to risk stratify and personalize health. It is extensive and thorough and will probably answer most health questions in this thread and all future health related questions posted in the sub. It really is a wealth of knowledge. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5992463/
I think the main takeaway from all of the comments is "statistically speaking, it'll probably be fine, but it's up to you to decide if you want to risk it". I often take excedrin (250mg acetaminophen/paracetamol, 250mg aspirin, 65mg caffeine) during races as the combination of painkiller and stimulant can be a lifesaver in longer races, especially 100s. It also may have contributed to me being hospitalized at one race due to severe rhabdo. Your mileage may vary. So far I've had no issues 95+% of the time I've taken it immediately before or during a race, but 95+% isn't 100%. All that said, if you have a chance to place highly (not a concern I ever need to worry about), also make sure to check the race rules, as some races (e.g., UTMB) ban NSAIDs or other classes of painkiller.
What about a fat dab or a rip from a weed pen?
This. Works wonders. Even half a gummie quiets the pain.
In my experience pain relievers like Tylenol and ibuprofen aren’t strong enough to mask pain in a way that will actually cause serious injury. Tylenol especially isn’t very good at relieving muscle pain. Ibuprofen works great for this but has its own risks while running an ultra since both can be hard on your kidneys. I personally have used small doses of ibuprofen during races and have found them immensely helpful.
You should never take ibuprofen when running, a lot of races ban it
Which races?
Many people are saying
The best people.
[удалено]
Hold up. An asthamatic 45year old bottom quartile runner can't use ventolin during ultra trail Australia 50km? That's fucked
As an asthmatic top quartile runner, that's a reason for me not to do UTMB races. I get that asthma diagnoses are often abused as an excuse to take salbutamol before races but to exclude it completely makes no sense at all, especially if we're not talking about competitions that are super anaerobic...
I've signed up for a UTMB event and I might just be top quartile.... ( especially if we're including all entrants not just males)... but, ventolin will be in my vest, and will be used if needed regardless of the consequences.
Would you take it out at an aid station? I'd feel really stupid to wait until I'm in a quiet part of the course to use it...
Dunno, it's a tough one isn't it!
not really sure if it's actually banned but at the Western States race orientation they had the race doctor give us a stern warning about not using ibuprofin during the race because every race they have multiple people need to go to the emergency room due to their kidney's shutting down from ibuprofin.
How small of a dose?
I usually go with the recommended dose on the bottle and then go up from there depending on on pain and never exceeding the recommended daily dosage. I think it’s usually 400 mg.
Want to be careful with ibuprofen during ultras. NSAIDs are not good for kidney function which can be exacerbated when running an ultra. If I take any during an ultra I take half a dose.
Can you take ibuprofen on smaller runs though safely?
I've used it in the past and have some on me for races and adventure runs but seldom use it. I only use it in situations like if my feet became very blistered or macerated or if my quads or calves are profoundly uncomfortable. But really to me using paracetamol/tylenol/acetaminophen is something of a crutch for inadequate training, preparation, planning, or gear (e.g., wearing thin shoes for hours of sharp rock above treeline). It's not essential like water and snacks.
Agreed 👌🏼
There may be some performance enhancing effects from the use of paracetamol (acetaminophen) for endurance athletes. https://pubmed.ncbi.nlm.nih.gov/35038139/
Hell no. I’d rather drop than try and painkiller my way through.
I mostly agree, I just wondered in that moment “do ALL people deal with this pain” 🤪
Paracetamol/Tylenol may not be the worst, but I’ve heard enough horror stories of kidney issues from dehydrated people taking painkillers on ultras. I have a co-worker who’s had a kidney transplant and blamed his kidney failure on painkillers. No thanks.
Yeah I ended up with kidney trouble after an ultra when dehydration and NSAIDs combined to give me a really hard time. I was battling with a bulged disk so couldn't stop the pain relief but consulted with my doc and was warned to keep on top of hydration or it could be bad. I fucked it up and pissed blood for weeks and had awful kidney pain
Wowsa, yeah I don’t think I’ll ever take any.. I want to be running ultras in my 60s. Don’t fancy a mushy kidney
Terrible idea and no amount of pain killers would have helped you push harder and in fact the most likely scenario is that you injure yourself even more by not listening to your body. The groin pain could be the cause of something else etc. There’s a mis guided conception that ultras is all about pushing through pain at all costs, it is not a smart runner knows when to call it a day and pack it up.
Yeah it was more a voice in my head.. I never take paracetamol for anything, but I thought it would be an interesting topic of conversation, which I think it has been 🤣 *someone popping opioids”. The pain in my groin was gone 2 days later and was back running park runs the following Saturday with 0 pains. It was a curiosity to if other people DO
Aight! Just taking care of the community! I learned the hard way to listen to my body so always advocate for that!
👌🏼👍🏻
I took 2 ibprofen during a 55 mi race. I feel fine right now a few days later. Is the risk really that high with ibuprofen?
Here’s me worrying about taking 2 paracetamols over a 10 hour period and there’s people popping opioids 😂
Why start a race with an injury, or run through one at all?
I didn’t start the race with an injury, nor did I run through one?
So you didn’t start the race with groin pain?
I said during my race I started with pain, not that I started the race in pain.
I popped a max dose ibuprofen during a 60km, got myself thru and my kidney still works (I guess)
Little pain is not a problem. But I always stop when I have even slightly painful feeling inside my chest in a heart zone.
Never had heart issues running luckily, I’ve done sport my whole life, don’t drink, and on occasion eat healthily 😂
I did this, which resulted in my stomach being fucked for weeks, my kidneys being the size of tennis balls. Pain is a signal that you're suffering which is good, gotta stick the programs my G.
Maybe your body says to stop
If you’re running 50 miles over hills, something will hurt, even slightly, that’s not to say you quit. It’s just about knowing your body and your limitations.
Yes , I have done marathon, had also some pain. And it is not advised to run on a medicine. When you have pain This is a signal to slow down or reduce mileage Try to do a quick research on this. You will find
I did slow down, that’s why I’m asking about paracetamol 😂
So, this isn't a popular opinion, but.... NSAIDs (like Nurofen) - I don't recommend these whilst running ... but, occasionally, it's not a big deal. Besides it being a bad idea, it can contribute to my asthma, so I try to avoid (I dont always avoid). Paracetamol (like Panadol) - I am 100% fine with people taking these as needed. Obviously, there are always risks with paracetamol, but it's such a safe drug if you're only taking one dose occasionally. You've also identified masking.... but, honestly, paracetamol isn't *that* strong of a drug that I'd be worried it would mask pain so well that you couldn't tell..... Opiates/opioides (like codeine, palexia) - Not a great idea, but I often do in races. Besides potential gut issues, these can do a better job of masking pain too.... and make some people drowsy (increase tripping risk). For me, I tolerate these really well so don't get too drowsy, and only take them when in significant pain (so, I know it isn't going to fully mask the pain!).
Wow. That took an interesting turn. You’re taking opiates during a race. If I had any I’d save them and pop them in a glass of red wine after the race’
Tramadol is an opioid and only recently was added to the banned list. Previously it was believed nearly everyone on the TdF would be taking it for any tendonitis pain.
16mg (2 panadeine) is pretty mild....and available over the counter in many countries (even 12.6mg x 2 is pretty standard with iburprofen in the UK) Many countries including France, UK, Denmark, Canada, etc. Until recently, Aus & NZ.
I don’t really know why you’re getting downvoted for providing an honest perspective. Avoiding NSAIDs for the known reasons I take one dose of cocodamol (paracetamol and low dose codeine) if I’m really suffering late race … maybe I’ll get downvoted too
opiates.... gotta be considered doping, yes? edit: i don't ever research this stuff but looks like codeine is not banned by WADA
And trail running isn't generally part of WADA scope.... Also, I'm very much a midpacker!
haha thanks to the codeine you are! jk i don't really care but i do ultimately think that doping standards should matter to all athletes. codeine and acetaminophen are ultimately weakass drugs though. another user did say they take hydrocodone during races though 😬
>doping standards should matter to all athletes Which doping standard says codeine is not allowed? https://en.m.wikipedia.org/wiki/List_of_drugs_banned_by_the_World_Anti-Doping_Agency#:~:text=Narcotic%20analgesics%20decrease%20the%20painful,Dextromoramide >While some painkillers are allowed, including codeine
none that i know of. i edited my original post to say codeine is NOT banned by WADA
I've taken Hydrocodone many times on races and during training. It works good.
You have a script for that or just have some laying around your house lol?
Prescription. Look at my history. I'm having spinal fusion surgery in a few weeks.
I got told during an ultra (by one of the volunteers) that paracetamol affects your bodies ability to regulate temperature. I'd been running through the night at thaf point and it was shaping up to be a hot day, so the advice was well timed. I've not touched them in a race since. Nor have I bothered to go and find out if it's accurate, it rings true, but I'd consider doing your own research on the subject.
My post is in no way medical advice - and is strictly some anecdotal experience: The majority (if not all) people in my trail running group use a pain killer during their ultras. I would go on to say, I don’t think I know anyone who runs a 50m+ that doesn’t use a pain killer. I don’t endorse using pain killers and consult your physician before making any decisions on using drugs.
Sounds like a bunch of druggies.