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

Marathon Runners
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Marathon runners and walkers often choose to take pain relievers before or during a marathon, or perhaps during their training. It's no surprise why: Long-distance running can take quite a toll on the body and lead to muscle aches, joint pain, and more. But before you take pain medication for a marathon, it's important to consider some of the risks in doing so. Pain medications could help you push through, but they also have the potential to keep you from the finish line and even cause harm.

Just as you have likely well-researched the best steps to take to prepare you for your race, learn more about pain relievers and marathoning so you can make the best choices for you.

If you regularly take pain relievers for a condition, talk to your doctor about whether you should use them on long training runs and walks and in marathon conditions.

When You Can Take What

Generally speaking, here is what marathon medical directors advise in terms of pain reliever use before, during, and after a marathon:

Pain Reliever Before During After
NSAID No No Yes***
Acetaminophen Yes* Yes** Yes***
Aspirin No No Yes***

*If you have pre-race pain, try taking just one regular-strength Tylenol (acetaminophen) before your run.

**Experts give a very tentative nod to acetaminophen if a pain reliever is needed during the race, as long as it is used as directed.

***For acute pain following a race, wait at least two hours and make sure you have rehydrated before taking acetaminophen, ibuprofen, or aspirin. Always take as directed and do not combine different types of pain relievers. Note: Most pain relievers should be used for no longer than four days.

Problems With NSAIDs

The most common over-the-counter non-steroidal anti-inflammatory medications are Advil and Motrin (ibuprofen) and Aleve (naproxen). They have two effects: pain relief and inflammation reduction.

If you've ever run long distances, you know why these two benefits are particularly appealing. One 2011 study of participants in the Brazil Ironman Triathlon found that 60 percent of the triathletes used anti-inflammatory drugs in the three months prior to the event. Unfortunately, the research also revealed that most of the participants were unaware of the potential negative effects.

While you may not usually have problems with NSAIDs, you are putting your body under extreme conditions for 26.2 miles when you run a marathon. It's possible that you may have an unexpected (and potentially race-ending) reaction.

In fact, a large-scale 2013 study looked at almost 4,000 marathon runners found five times more adverse effects during the race among those who took over-the-counter pain relievers beforehand. (The most common problem was gastrointestinal upset.)

NSAIDs are only safe to take after the finish, and then only after you have urinated once (showing you are not dehydrated and your kidneys are functioning).

Some of the specific dangers associated with the use of NSAIDs when running include the following:

Kidney Damage

In addition to causing nausea, these drugs can decrease kidney function; they inhibit prostaglandins—hormones that help regulate blood flow to the kidneys. The physical exertion of the race combined with the use of NSAIDs and possible dehydration can be a dangerous mix.

In the previously mentioned 2013 study of marathon runners, three racers who took ibuprofen immediately before the race reported they were hospitalized with temporary kidney failure. Another study of 89 ultramarathoners found that those who took ibuprofen (400 milligrams every four hours) during a 50-mile race were more likely to have acute kidney injury than those who took placebos.

Inflammation

Mixing these pain relievers with intense exercise can backfire. Perhaps counterintuitively, researchers have also found that runners who take ibuprofen before and during endurance races display higher levels of inflammation afterward.

NSAIDs may not help you during the race in any case. One study found no difference in performance between runners who took ibuprofen for muscle aches and those who took a placebo.

This does not mean that NSAIDs need to be avoided altogether. They can be an effective part of your recovery if you have acute pain or inflammation in some part of your body, particularly if you are using them in conjunction with rest, ice, and elevation.

Natural Alternatives

If you want to decrease your general muscle soreness and aches associated with running, try increasing the amount of quercetin and polyphenols in your diet. These natural anti-inflammatories, found in foods such as onions, apples, plums, and grapes, may help reduce muscle pains that result from regular training.

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 have excessive oxidative stress, as when running or walking a marathon.

Nausea

Some people get nauseous from acetaminophen, which is already a common complaint of marathoners. Even if you normally do not experience this side effect when taking acetaminophen, you might find yourself feeling queasy before you are able to finish your run.

Liver Damage

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 NSAIDs. If you lose track of how much you are taking, you can damage your liver permanently; an overdose is not treatable.

Problems With Aspirin

Aspirin has three effects: pain relief, fever reduction, and anti-inflammation.

Aspirin also inhibits the ability of the blood to clot effectively in most people. This can result in bleeding more if you have an injury, but experts also raise concern about the drug's use in marathons because all of those miles of pounding can lead to more micro-bleeding and burst capillaries, which the drug can worsen.

Many people experience nausea and even gastric bleeding from aspirin. In the 2013 marathon study, four racers who took aspirin reported being hospitalized with bleeds and two with cardiac infarctions.

If you regularly take low-dose aspirin to help manage a condition or health risk, discuss your situation with your doctor for advice on how marathon running may impact your dosage and use.

A Note About Alcohol

Alcohol is not advised during a run, especially if you have taken any other pain medication. While having a pint has anecdotally been reported to have a pain-relieving effect, it's best to pass the informal beer stops you may see near the end of the race. Wait until you have recovered with appropriate fluids before you enjoy a celebratory drink.

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