Pain management in elite sport: A doping problem, a public health ethics issue, or both?

Abstract

A clear rationale for inclusion of tramadol in the Prohibited List was not provided and is not likely that it will be provided by WADA. We argue however that it would be important to publicly recognise at the level of WADA and of individual sports organisations that associating pain tolerance with a masculine sport ethics can have harmful consequences. For example, encouraging athletes to downplay their own painful experiences, as well as discouraging them from seeking necessary medical care, with longterm and sometimes irreversible consequences for their health. In addition, it is important to also publicly recognize that different athletes have different baselines to pain, independently of their gender (Zandonai et al., 2021b) Finally, WADA and the federations need to ensure that athletes have access to comprehensive healthcare, appropriate education on injury prevention and treatment, as well as psychological tools to support their mental health. It is also equally important that sports physicians are put in a situation where they can effectively prioritise the care of their athletes/patients. For an ethical management of pain in elite sport, it is essential that both athletes and sports physicians are put in a position to be able to prioritize the athletes’ health and well-being, and to use analgesic drugs responsibly to treat acute pain due to injury with a view towards their long-term health, not as a means for a faster return to play or to compete through an injury or to raise their tolerance to pain in edurance events. Sport organizations need to also play a role in promoting a behavior aimed at that goal and discourage the perpetuation of a masculine sport ethics of playing through pain.