Prévalence d'usage d'analgésiques chez les jeunes athlètes

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Prevalence, frequency, adverse events, and reasons for analgesic use in youth athletes: a systematic review and meta-analysis of 44,381 athletes
Julie Rønne Pedersen Journal of Science and Medicine in Sport September 3, 2022

Objectives
To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes.
Design
Systematic review and meta-analysis.
Methods
Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15–24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively.
Results
Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48 % [95 % CI 23 % to 73 %], in-season prevalence 92 % [95 % CI 88 % to 95 %]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2 % [95 % CI 1 % to 3 %]). Seven to 50 % of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3 % to 19.2 %. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance.
Conclusion
Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesics use to understand consumption trajectories.

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Sex differences in the consumption of over-the-counter analgesics among amateur volleyball players
Lisa Hager BMC Sports Sci Med Rehabil. 2021 Apr 29;13(1):45.

Background: Compared with the normal adult population, athletes of several sport disciplines, such as endurance sports, ball sports, cycling and swimming, have higher use of over-the-counter analgesics (OTC analgesics). The aim of this study was to describe the epidemiology of OTC analgesic use in volleyball players as a typical competitive sport discipline. One particular focus was placed on the analysis whether the athletes' use of OTC analgesics was influenced by their performance motivation.

Methods: A cross-sectional survey among amateur volleyball players was carried out using a web-based sports questionnaire. The study included athletes of both sexes, 18 years and older, currently playing in a German volleyball league. The athletes' sport-related complaints were evaluated regarding the use of OTC analgesics. The use of OTC analgesics by athletes was compared with their performance motivation, based on the "Achievement Motives Scale - Sport" (AMS-Sport) questionnaire.

Results: The analysis of 114 completed questionnaires of amateur athletes revealed that the use of OTC analgesics was sex dependent, with a higher prevalence of use in female players (60%) versus male players (38%). The main reasons for consumption of OTC analgesics were pain in the head, knee and shoulder. The most frequently taken drug was ibuprofen, most often taken at competitions and over a period of 4 years (median). The analysis of the AMS-Sport questionnaire revealed that a logistic regression model for estimating the probability of drug use can be explained by the factors hope of success and years of playing practise in female players but not male players. In females, an increase in the factor hope of success resulted in a lower probability of OTC analgesic use, while an increase in years of playing practise resulted in a higher probability of use.

Conclusion: The average duration that volleyball players in this study took OTC analgesics was higher than that of the German population, and OTC analgesic use was more prevalent in female than male volleyball players. Thus, to reduce the prevalence of OTC analgesic use, educational programs should be implemented in sports teams; and, to reduce direct and indirect social pressure, sports teams should also receive sex-specific psychological support.

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Pain medication use in youth athletes: A cross-sectional study of 466 youth handball players
Dilara Merve Sari TRANSLATIONAL SPORTS MEDICINE 15 November 2021

The aim of this study was to determine the 4-week prevalence of pain medication use in youth athletes, the type of medication used, the reasons for use, and from where the athletes obtained the medication. 466 handball players (aged 14-18) were surveyed about their pain medication use within the preceding 4 weeks. The questionnaire consisted of 3 parts: type of pain medication used (if any; non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen/paracetamol, and acetylsalicylic acid (ASA)), the reasons for use, and from where it was obtained. 190 players (41% [95% CI 36%-45%]) reported pain medication use within the last 4 weeks. Paracetamol was the most reported type (n = 157, 83% [95% CI 77%-88%]), followed by NSAIDs (n = 98, 52% [95% CI 44%-59%]); 67 reported “injury-related reasons” for their use, and most participants reported to obtain the pain medication via “from home or bought over-the-counter (OTC)” (n = 167, 88% [95% CI 82%-92%]). Pain medication use in youth handball players is common, particularly among female players, and a substantial proportion of the overall use is due to injury-related reasons. The vast majority of the players got their pain medication from home or purchased it OTC. Further research is needed to comprehend these patterns of use, including the long-term use.

[Nutrimuscle-Diététique]

Traduction de l'étude

Utilisation d'analgésiques chez les jeunes athlètes : une étude transversale de 466 jeunes joueurs de handball
Dilara Merve Sari MÉDECINE SPORTIVE TRANSLATIONNELLE 15 novembre 2021

Le but de cette étude était de déterminer la prévalence sur 4 semaines de l'utilisation d'analgésiques chez les jeunes athlètes, le type de médicament utilisé, les raisons de l'utilisation et d'où les athlètes ont obtenu le médicament. 466 joueurs de handball (âgés de 14 à 18 ans) ont été interrogés sur leur utilisation d'analgésiques au cours des 4 semaines précédentes. Le questionnaire comprenait 3 parties : type d'analgésique utilisé (le cas échéant ; anti-inflammatoires non stéroïdiens (AINS), acétaminophène/paracétamol et acide acétylsalicylique (AAS)), les raisons de l'utilisation et d'où il a été obtenu . 190 joueurs (41 % [IC 95 % 36 %-45 %]) ont déclaré avoir utilisé des analgésiques au cours des 4 dernières semaines. Le paracétamol était le type le plus signalé (n = 157, 83 % [IC à 95 % 77 %-88 %]), suivi des AINS (n = 98, 52 % [IC à 95 % 44 %-59 %]) ; 67 ont rapporté des « raisons liées à des blessures » pour leur utilisation, et la plupart des participants ont déclaré avoir obtenu les analgésiques via « à domicile ou achetés en vente libre (OTC) » (n = 167, 88 % [IC à 95 % 82 % - 92 %]). L'utilisation d'analgésiques chez les jeunes joueurs de handball est courante, en particulier chez les joueuses, et une proportion substantielle de l'utilisation globale est due à des raisons liées à des blessures. La grande majorité des joueurs ont obtenu leurs analgésiques à la maison ou les ont achetés en vente libre. Des recherches supplémentaires sont nécessaires pour comprendre ces modes d'utilisation, y compris l'utilisation à long terme.

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Cross-species comparisons reveal resistance of human skeletal stem cells to inhibition by non-steroidal anti-inflammatory drugs
Front. Endocrinol., 25 August 2022 L. Henry Goodnough

Fracture healing is highly dependent on an early inflammatory response in which prostaglandin production by cyclo-oxygenases (COX) plays a crucial role. Current patient analgesia regimens favor opioids over Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) since the latter have been implicated in delayed fracture healing. While animal studies broadly support a deleterious role of NSAID treatment to bone-regenerative processes, data for human fracture healing remains contradictory.

In this study, we prospectively isolated mouse and human skeletal stem cells (SSCs) from fractures and compared the effect of various NSAIDs on their function. We found that osteochondrogenic differentiation of COX2-expressing mouse SSCs was impaired by NSAID treatment. In contrast, human SSCs (hSSC) downregulated COX2 expression during differentiation and showed impaired osteogenic capacity if COX2 was lentivirally overexpressed.

Accordingly, short- and long-term treatment of hSSCs with non-selective and selective COX2 inhibitors did not affect colony forming ability, chondrogenic, and osteogenic differentiation potential in vitro. When hSSCs were transplanted ectopically into NSG mice treated with Indomethacin, graft mineralization was unaltered compared to vehicle injected mice. Thus, our results might contribute to understanding species-specific differences in NSAID sensitivity during fracture healing and support emerging clinical data which conflicts with other earlier observations that NSAID administration for post-operative analgesia for treatment of bone fractures are unsafe for patients.

Evidence from a mechanistic perspective that NSAID does not appear to impair human skeletogenic stem and progenitor cells and contributes to the hypothesis that NSAID use might be safe after fractures in humans in some contexts.

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Traduction de l'étude

Des comparaisons entre espèces révèlent la résistance des cellules souches squelettiques humaines à l'inhibition par les anti-inflammatoires non stéroïdiens
De face. Endocrinol., 25 août 2022 L. Henry Goodnough

La guérison des fractures dépend fortement d'une réponse inflammatoire précoce dans laquelle la production de prostaglandines par les cyclo-oxygénases (COX) joue un rôle crucial. Les schémas thérapeutiques actuels d'analgésie des patients favorisent les opioïdes par rapport aux anti-inflammatoires non stéroïdiens (AINS), car ces derniers ont été impliqués dans le retard de cicatrisation des fractures. Alors que les études animales soutiennent largement un rôle délétère du traitement par AINS sur les processus de régénération osseuse, les données sur la guérison des fractures humaines restent contradictoires.

Dans cette étude, nous avons isolé de manière prospective des cellules souches squelettiques (SSC) de souris et humaines à partir de fractures et comparé l'effet de divers AINS sur leur fonction. Nous avons constaté que la différenciation ostéochondrogénique des SSC de souris exprimant COX2 était altérée par le traitement par AINS. En revanche, les SSC humains (hSSC) ont régulé négativement l'expression de la COX2 au cours de la différenciation et ont montré une capacité ostéogénique altérée si la COX2 était surexprimée de manière lentivirale.

En conséquence, le traitement à court et à long terme des hSSC avec des inhibiteurs non sélectifs et sélectifs de la COX2 n'a pas affecté la capacité de formation de colonies, le potentiel de différenciation chondrogénique et ostéogénique in vitro. Lorsque les hSSC ont été transplantées par voie ectopique chez des souris NSG traitées avec de l'indométhacine, la minéralisation du greffon n'a pas été modifiée par rapport aux souris injectées par le véhicule. Ainsi, nos résultats pourraient contribuer à comprendre les différences spécifiques aux espèces dans la sensibilité aux AINS pendant la cicatrisation des fractures et soutenir les données cliniques émergentes qui contredisent d'autres observations antérieures selon lesquelles l'administration d'AINS pour l'analgésie postopératoire pour le traitement des fractures osseuses est dangereuse pour les patients.

La preuve d'un point de vue mécaniste que les AINS ne semblent pas altérer les cellules souches et progénitrices squelettiques humaines et contribue à l'hypothèse selon laquelle l'utilisation des AINS pourrait être sans danger après des fractures chez l'homme dans certains contextes.