TSN Original: The Problem of Pain
The Canadian Athletic Therapists Association (CATA) plans to form a task force to better educate members about the issue of painkillers and informed consent in both amateur and professional sports.
CATA president Michael Robinson said the move is taking place in response to TSN’s documentary feature The Problem of Pain, which aired Tuesday night on That’s Hockey.
The CATA has 2,000 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 discipline committee has the power to investigate members for inappropriate activity and fine and/or suspend their certification.
Some head athletic trainers 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.
“We need to do a ton more education,” Robinson said in an interview on Wednesday. “There’s clearly a deficiency. We need better education for our members – either at universities when they are studying to become athletic therapists or with continuing education about painkillers. Our members need to understand what it means to have informed consent. I don’t think they all have that knowledge.”
Robinson said CATA’s board is also planning to host a webinar in October to discuss the issue of pain management in pro sports.
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.
“Whether someone makes a decision to take Toradol off-label, for more than the recommended five-day limit, that’s their decision to make,” Robinson said. “But based on what these players are saying, they aren’t being given the necessary background information to make an informed decision. Do some of these players even know what Toradol is? This transparent conversation needs to be had. If you were going to go for surgery, a doctor would sit down and say, ‘Here are the risks.’ We need the same in sports, including in the NHL.”
The CATA sent an email on Tuesday night to NHL commissioner Gary Bettman, NHL Players’ Association executive director Donald Fehr and Forss of the Oilers, who is also secretary of the Professional Hockey Athletic Trainers Association, a group whose members also work in the AHL, CHL and NCAA.
“The off-label use of medication is not prohibited by Health Canada, however patients who are being administered medication off-label by a member of the CATA must be educated on the risks, side-effects and long-term implications,” the CATA’s email said.
No certified athletic therapist in Canada has been disciplined for administering anti-inflammatories, Robinson said. (Canadian programs train certified athletic therapists while their official title in the U.S. is certified athletic trainers.)
Tyler Quennell, a CATA vice-president who is a certified athletic therapist with the Toronto Rock lacrosse team, said he’d like to see the CATA partner with the U.S. National Athletic Trainers’ Association to create a North America-wide task force.
Quennell also said he wants professional sports teams and perhaps junior hockey clubs to consider expanded education programs about the long-term consequences of pharmaceuticals for players before the season begins, sessions that might also include the spouses of players, or, in the case of players in junior hockey, their parents.
“Wives are going to be the ones who probably help to dish [medications] out at home, the ones who read the labels closely and know whether to take things with food or after meals or with a lot of water,” Quennell said. “The wives may be the voice of reason to say, ‘You’ve been on this a long time and you’re still in pain.’ But my worry would be whether having them more involved could create more hiding. A player might think, ‘Now I need to hide from my coaches and my wife. You will get players with that mentality. The pills will stop coming home and they’ll start sitting in the glove box of the car.”
Robinson said any change won’t be universally accepted. He said some CATA members don’t support the prospect of a task force or educational webinar.
“We’ve had pushback from a few of our old-school people,” he said. “Their perspective is this is a doctors’ issue, and this isn’t our problem. But I think they’re wrong. We’re part of the team. We’re seen as a trusted expert. If the players are relying on us, we need to make sure they are well informed.”