TSN Original: The Problem of Pain
The Canadian Athletic Therapists Association (CATA) and a pain management researcher in Montreal have received funding to study the use of painkillers and anti-inflammatory drugs in amateur and professional sports.
Dr. Geoff Dover, an associate professor of health, kinesiology and applied physiology at Concordia University in Montreal, and CATA have received $80,000 in grant money from Mitacs, a national not-for-profit organization that fosters growth and innovation in Canada.
CATA president Tyler Quennell said the research grant application was filed in response to TSN’s documentary feature The Problem of Pain, which aired in September 2020 on That’s Hockey.
“While we as athletic therapists do not prescribe medication, we are responsible for the health and rehabilitation of all athletes including those who have been prescribed medication,” Quennell wrote in a CATA newsletter that will be distributed to members on Wednesday. “Although a robust curriculum is currently available to athletic therapists across the country, few requirements about pain and pain medication education currently exist. This potential gap was brought to light last year in the documentary ‘The Problem of Pain.’”
CATA has 2,800 members in Canada, some of whom work in professional sports leagues such as the National Hockey League and the American Hockey League, and with junior players in the Canadian Hockey League. The association is self-regulating, and its ethics committee has the power to investigate members for inappropriate activity and fine and/or suspend their certification.
Some head athletic therapists who work for NHL teams are members of CATA, including Ottawa’s Domenic Nicoletta, Edmonton’s T.D. Forss, Toronto's Paul Ayotte, Winnipeg's Rob Milette, Montreal's Graham Rynbend, and Vancouver’s Jon Sanderson.
In The Problem of Pain, former National Hockey League players Ryan Kesler, Kyle Quincey, and Zenon Konopka discussed their concerns that players are not being advised about the potential long-term risks of taking anti-inflammatories such as Toradol, a prescription painkiller that is not supposed to be taken for more than five days.
Kesler, Quincey, and Konopka, as well as other active players, told TSN in interviews that they have taken Toradol for months at a time without being advised by NHL trainers or doctors about the potential long-term health risks.
Kesler has been diagnosed with colitis and Crohn’s disease and said doctors have told him his condition was most likely triggered by his Toradol use.
“What most athletic therapists fail to realize is the prevalence of [anti-inflammatory] use,” Quennell wrote in his release.
Dover said research would include establishing a focus group made up of researchers, athletic therapists, and athletes that will explore the most up-to-date science about the use of pain medication.
“Pain is one of the most important things we can treat as athletic therapists,” Dover said in an interview. “This grant will fund research that will determine what aspects of pain and pain medication every student athletic therapist will learn about while studying. We will also make a continuing education course to ensure current athletic therapists have the most up to date evidence-based information.”
The Mitacs funding will also pay for an examination of past published medical studies about how anti-inflammatories are used to treat various sports injuries. Quennell wrote in his release that there are few recent studies on the subject.
"An update on this topic is critical," he wrote.
In a study published in July 2012 in the medical journal Sports Heath that was purported to be the largest survey of the use of Toradol in athletes, researchers at Brown University canvassed 6,950 orthopedic surgeons and nonsurgical doctors. Of the 1,110 respondents, 49 per cent said they used Toradol in the treatment of athletes, primarily at the collegiate and professional levels.
Two point nine per cent of respondents said they had administered Toradol to athlete patients who later experienced bleeding complications. One point nine per cent said they had athlete patients who suffered kidney complications after using the anti-inflammatory. The study didn't detail the number of those patients with adverse reactions to Toradol and wasn't designed to allow respondents to elaborate on the severity of the health complications.
Seventy-nine per cent of respondents said they used Toradol to treat collegiate athletes, compared to 42.9 per cent at the professional level and 15 per cent at the high school level.
Some doctors in the survey said they don’t administer Toradol to their own athletes but are willing to perform the injections on a visiting team athlete if requested by the player and team staff.
Dover said he also hopes to begin a trial that would include up to 75 athletes and 75 control members to explore whether athletes tend to have a higher pain tolerance than the general public.
Dover also plans to research the phenomena known as “pain catastrophizing,” which refers to how some people perceive and fear pain and the brain’s role in responding to pain and injury recovery. Researchers will explore whether improving an athlete’s mental health can reduce pain.
In June, the NFL and NFL Players Association said they would provide $1 million in funding for up to five research projects that would explore pain management and cannabinoids.
Dover said there are no plans to include cannabinoids in his research because it isn’t his area of expertise.