Playing Through the Pain

It’s not news that the NFL has a problem when it comes to the things players do (and what team physicians allow them to do) in order to be able to suit up for games every Sunday for 16 weeks in the fall. But just how big of a problem it is, specifically relating to Toradol, a prescription painkiller, and the fact that it continues to be one, might be a little bit surprising.

In an article in Sunday’s Washington Post, Sally Jenkins and Rick Maese—two well-distinguished sports journalists in the nation’s capital—reported on a survey the Post completed earlier this month of 512 former NFLers, about playing through pain.

Nearly nine-in-10 surveyed reported playing in games while hurt, and more than half said they played through pain equally because they wanted to satisfy their coaches and because they wanted to. Seven-in-10 said they took Toradol, with a majority saying they took it regularly to mask the pain they anticipated that they would feel during football games.

Toradol—for you nonpharmacy graduates (myself included)—is a nonsteroidal, anti-inflammatory drug (NSAID). It’s not a narcotic and isn’t addictive, but it’s only available with a prescription and is most often used post-surgery to manage pain. It is, however, considered dangerous enough that some countries in Europe ban the drug, while others only make it available in hospitals. Known potential side effects of overuse, according to the Post article, include kidney damage and gastrointestinal bleeding.

What makes overuse in the NFL so problematic is that the drug essentially cancels out one’s ability to feel pain or be aware of an injury that they might have suffered, and, because it it an anticoagulant (it prevents blood from clotting) it can potentially can make worse the effects of a concussion—which is why part of the lawsuit former players have brought against the league includes the players claiming their team doctors “treated” them with Toradol without properly warning them about the potential dangers of using the drug.

Several former players interviewed for the article helped shed some light on the extent to which the painkillers were (and probably still are) abused.

When Fred Smoot, a former Washington Redskins defensive back, fractured his sternum and had to spend four months sleeping in a recliner because he couldn’t lie flat, he said his team doctors gave him a choice: Miss the rest of the season or “figure out a way to play.” Worried about his livelihood, he made it on the football field each Sunday thanks to a syringe full of a drug called Toradol.

“Painkillers are like popping aspirin,” Smoot said. “They get to that point.”

ESPN NFL analyst Mark Schlereth, who has made clear in his on-air time just how many surgeries he’s had (29) and how he always played through pain, was able to suit up less than 24 hours after a kidney-stone operation thanks to some pill popping and injections.

“I would strap a dog turd to it if I thought that would make me feel better,” he said. “Bottom line is, I’d do whatever I have to do. Have I had Toradol shots? Yes. Have I abused anti-inflammatories? Yes. Have I used painkillers? Yes. Have I got shot up with painkillers and Xylocaine and different things to numb areas so I can play? Yes. I’ve done it all.”

Jenkins and Maese site a 2000 survey of NFL physicians which found that 28 of 30 teams used Toradol injections on game days. Another study done two years later found that 15 pregame injections was about normal for teams.

Hall of Famer Warren Sapp gave probably the best quote on the pregame line.

“No doubt about it, I was in that line. They’re like Tic Tacs. You walked in, you got it and you played the game.”

Relying on the drug—on top of whatever else players were able to get their hands on to help relieve or “prevent” pain—often led to abuse, something Scott Fujita, a 10-year veteran free agent, mentioned in his interview for the article. He said that his usage—about four or five days a week—was probably on the low end compared to some of his teammates.

On Thursdays, Fridays and Saturdays, Fujita might rely on Celebrex or another anti-inflammatory. If the pain from a specific injury was really bad, the linebacker might turn to Vicodin or Percocet. On Sundays, he’d get a Toradol shot before taking the field. Then with fresh aches and pains, he’d spend Mondays on another pill to help recovery. Tuesdays and Wednesdays, though, were always different — “your chance to detox a bit.”

“We called it DFW,” he said. “Drug-Free Wednesday.”

Fujita says he has suffered dozens of injuries during his career, from cuts requiring stitches to broken fingers to separated shoulders and torn muscles. To manage the constant pain, he has used “everything under the sun.”

“People spend so much time talking about HGH, steroids, and I think these are the real performance enhancers,” Fujita said.

League officials and team physicians interviewed for the article said that they were doing their best to make the move away from having painkillers (specifically Toradol) so easily available to players, but it all sounded like hogwash to me. And the situation involving New Orleans Saints assistant head coach Joe Vitt (read the article to get all the details) probably doesn’t even begin to scratch the surface of how widespread the problem the league faces.

As I’ve written about previously, though, until players begin to put their well-being ahead of winning or cashing that weekly check (which, let’s be honest, isn’t ever going to happen), it falls on the shoulders of the NFL brass, coaches, team physicians, and the like, to get this thing sorted out.

If the NFL were to be looked at through the lens of a typical office, the culture would be seen as toxic. It’s spiraling out of control right now, and I don’t know that Roger Goodell, or anyone for that matter, really has a sense of how, or the ability to, stop it.

Stats from the Washington Post survey:

(Click to enlarge image)

post survey

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