Dr Conor McGrane’s advice to Irish riders on painkiller Tramadol

Posted on: November 29th, 2015

Dr Conor McGrane, left, explains what the painkiller Tramadol does for cyclists using it and issues his own advice to Irish riders. Seen here aiding Rás yellow jersey Mark Cassidy after a crash in 2008.

 

By Dr Conor McGrane

Cycling is tough; a great sport but very tough.  As the great Jean de Gribaldy said: “Cycling isn’t a game; it’s a sport.

“Tough, hard and unpitying, and it requires great sacrifices. One plays football, or tennis, or hockey. One doesn’t play at cycling.”

Injuries are common especially fractures; the collarbone or clavicle often broken by riders several times in a career.

 

Painkillers

One of the problems doctors working within cycling have is giving painkillers that adequately relieve the pain from injuries while minimising the side effects.

As a rule, the stronger the pain killer the more side effects.

Paracetamol is considered the best first line painkiller and is generally free from major side effects if taken as directed.

Anti-inflammatories are also used and may be a little stronger but can cause stomach problems and may delay healing.

The next level of pain killers usually involves codeine; either on its own or in combination with paracetamol.

This commonly causes drowsiness and constipation. Longer term use can also lead to addiction.

 

Tramadol explained

Tramadol is a painkiller that was launched in Ireland about 20 years ago for moderate to severe pain.

Like codeine, and indeed morphine, it is a form of opiate. It is consumed mostly in pill format.

It acts relatively selectively on the miu receptors; one of six receptors opiates affect in the body.

Using medical terminology can be confusing. But it is important when discussing Tramadol because until relatively recently it was thought to have fewer side effects and to be less likely to cause addiction than other opiate based painkillers.

The World Anti-Doping Agency (Wada) tends to monitor drug usage in tested athletes, even for drugs not currently banned. Monitoring should reveal if emerging patterns of use or abuse are developing.

Sports medicine researchers also listen to athletes and try to see if drugs are being abused.

Tramadol is a strong and effective pain killer. Used properly it is excellent for severe injuries, fractures and muscular and soft tissue injuries.

 

Abuse and ‘finish bottles’

Unfortunately it has become clear that in cycling it is also being abused.

Athletes initially prescribed it for injuries have started to use it to relieve the pain of training and racing.

This pattern has become clear over the past five years or so.

There are also reports of it being used – along with other medications – in “finishing bottles” consumed in preparation for the end of a race.

Groups such as the Movement for Credible Cycling (MPCC) ask their members not to use it in competition, even though it is not banned.

Pro outfits such as Team Sky have also stopped using it as the possible abuse became more apparent and have called for it to be banned.

Although it has not been proven, there are those who think the use of Tramadol in races may be the cause of an increased number of crashes.

Michael Barry – formerly of United Postal Service and Team Sky – was quoted as saying he could push himself harder when taking Tramadol as it masked the pain in his legs.

“Tramadol made me feel euphoric, but it’s also hard to focus. It kills the pain in your legs, and you can push really hard,” he said in a newspaper interview.

And Lotto-Belisol team doctor Jan Mathieu has called for the substance to be banned.

He believed it was being abused on a widespread basis in the pro peloton and was contributing to crashes.

 

Monitoring and ban

Wada is reviewing its rules all the time and though the 2016 code does not list Tramadol as a banned or restricted drug, its status as a monitored substance may see it banned in time.

There is a growing clamour for it to be restricted to out of competition use. It is also becoming clear that it is more addictive than was first thought.

It may cause addiction or lead on to more addictive painkillers as its impact becomes reduced with more and more use over time.

For Irish cyclists, it is best to say it should not be used in competition.

Using it as prescribed after a serious injury is probably Okay. But this should be discussed with the prescribing doctor who should be told what sort of exercise or competition you take part in.

It is certainly not a drug like EPO that will dramatically increase your aerobic ability. But it is one that should be used with caution.

Cycling Ireland, as a member of the MPCC, has undertaken not to use it in competition for its athletes.

As with all prescription medications it has its place but using it as a cyclist should be discussed in detail with your doctor.

  • Dr Conor McGrane is a cyclist and as well as running his own medical practice has worked with Cycling Ireland as a doctor. He writes here in a personal capacity.

 

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