pain inflammation (special considerations)

Ibuprofen

GI bleeding; renal stress and BP elevation; dehydration and prolonged exercise may increase kidney risk; avoid stacking NSAIDs.

Naproxen

Longer acting; GI cardiovascular and renal risks; may mask symptoms and encourage premature return.

Ketorolac

Short-term use only; substantial GI bleeding and renal risk particularly with dehydration.

Aspirin

Increased bleeding and bruising; GI irritation; may exacerbate aspirin-sensitive asthma.

Acetaminophen

Hepatotoxicity with overdose alcohol or duplicate combination products; little anti-inflammatory effect.

Tramadol

Sedation dizziness seizures serotonin syndrome and dependence; prohibited in competition.

Fentanyl

Profound sedation and life-threatening respiratory depression; high misuse and overdose risk. Transdermal fentanyl is only for opioid-tolerant patients with persistent severe pain—not acute or postoperative pain. External heat fever and strenuous exercise can increase patch absorption and cause overdose; no athletic participation while impaired.

Hydrocodone/acetaminophen

Sedation respiratory depression constipation and dependence; calculate total acetaminophen exposure.

Oxycodone

Sedation respiratory depression misuse risk and impaired reaction time; can mask serious injury.

Oxycodone/acetaminophen

Opioid impairment plus acetaminophen toxicity risk from duplicate products.

Morphine

Significant sedation orthostasis and respiratory depression; incompatible with safe participation.

Lidocaine injectable

Temporary numbness and possible motor impairment can mask injury and alter joint protection. Systemic toxicity may cause tinnitus circumoral numbness metallic taste agitation seizures cardiovascular depression or respiratory arrest; intra-articular infusions have been associated with chondrolysis.

Naloxone

Emergency treatment of opioid overdose.

Diclofenac

Oral forms have significant cardiovascular GI and renal risks; topical use still creates some systemic exposure.

Meloxicam

Once-daily action may conceal persistent symptoms; renal cardiovascular and GI risks remain.

Celecoxib

Less platelet inhibition than many NSAIDs but cardiovascular and renal risks remain.

Indomethacin

More CNS and GI effects than many NSAIDs; dizziness or headache may affect participation.

Etodolac

May cause GI injury renal dysfunction elevated BP and edema.

Codeine/acetaminophen

Variable metabolism; sedation and respiratory depression; track total acetaminophen.

Lidocaine topical

Numbness removes protective pain feedback; should not be used to justify return to play.

Bupivacaine

Prolonged sensory loss can eliminate protective pain feedback and impair proprioception or motor function. Accidental intravascular administration or excessive dosing can cause severe CNS toxicity arrhythmias cardiac arrest and difficult resuscitation; return-to-play decisions should not be based on pain suppression after an injection.

Piroxicam

Long half-life and relatively high GI risk; adverse effects may persist after discontinuation.

Procaine

Less commonly used today; allergic reactions may relate to PABA metabolites or sulfite-containing products. Numbness removes protective pain feedback; systemic toxicity can affect the CNS and cardiovascular system. Use particular caution with prior local-anesthetic allergy or asthma history.