Dr. John Orchard on pain management in elite athletes: The CJSM Podcast

Dr. John Orchard, Chief Medical Officer of Cricket Australia (and so much more)

The September 2018 CJSM is a thematic issue on an issue of central importance in sport and exercise medicine:  the management of pain in the athletes we serve.

Many authors contributed to this special issue, with only a few more prolific than our guest on today’s podcast: John Orchard MBBS BA PhD MD.  Dr. Orchard was a contributing author on three of the original articles included in this issue:

Dr. Orchard is a wonderful interview, and so I hope you get to listen in — as ever you can go to our journal website to find all of our podcasts or to iTunes [iTunes link to Dr. Orchard’s podcast is currently pending, and we’ll post the podcast once it goes live on iTunes]. We covered a lot of ground in a short time during our conversation.  Among the stories Dr. Orchard shared with me was one of immediate relevance:  that of Cooper Cronk, rugby league player in the NRL played in that league’s Grand Finale with a fractured scapula (and a local anesthetic injection).

The readers of this blog and the listeners of the podcast should all know that Dr. Orchard is also a wonderful tweeter — one of our profession’s most important ‘follows’ I think. I you don’t already have him on your Twitter list, please find him @DrJohnOrchard and remedy that situation!

Thanks for following us here on the blog, on the podcast, and on our journal’s website.  As ever we appreciate your feedback, and we’d ask you specifically to comment on the podcast on iTunes if you are willing.  We are always interested in improving our content.

Marijuana and Athletic Performance: Help or Hindrance? The CJSM Podcast

In our newest CJSM podcast we tackle the controversial issue of marijuana in sports.

The September 2018 thematic issue, on the management of pain in athletes, includes many unique contributions to this important body of literature.  Indeed, it almost goes without saying that almost all patients I see in my clinic on a daily basis have, as part of their presenting condition, a complaint of pain.  I suspect this is true for you, too. Pain management is one of the most common issues we deal with as sports medicine clinicians.

One of those newly published studies is Cannabis and the health and performance of the elite athlete — it is an excellent discussion about many dimensions of this drug and its varied uses among elite athletes.  Among the conclusions the authors make: “The potential beneficial effects of cannabis as part of a pain management protocol, including reducing concussion-related symptoms, deserve further attention.”

A logical question, when considering use of this drug in the athlete, might be:  what are the potential negative side effects?  Or, for that matter, are there ergogenic effects with which we must be concerned?

In our July 2018 journal, a group of authors tackled these issues in a systematic review on marijuana and its effects on athletic performance.

Mr. Dion Diep, McMaster University

The corresponding author of the study, Dion Diep, is a medical student at McMaster University in Hamilton University.  He was able to join us for a podcast discussion of what his team found.  Mr. Diep is our first medical student guest on the podcast, and based on his erudite performance I would say he has a stellar career ahead, as a clinician and a researcher.

We cover a lot of ground in a short time in this podcast.  Can marijuana enhance athletic performance?  What negative effects does it have?  May it show promise as a targeted treatment of various athletic maladies, such as anxiety?  What is the rational for having marijuana on the WADA banned substances list?

As ever you can find this podcast, and all our podcasts, on our journal website as well as iTunes, where you are invited to subscribe to the podcast and ensure you get direct delivery of every new edition of this growing audio library.

When you’re done listening to the podcast and reading the studies, take the time to take the poll and consider leaving a comment here on the blog or on the iTunes link. We’re always looking to hear from you — your contribution to the global conversation on clinical sports medicine is invaluable, and your feedback will help us continuously improve what we share with you.

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Marijuana and Its Effects on Athletic Performance: A Systematic Review

Cannabis and the Health and Performance of the Elite Athlete

 

Is it safe? Local anesthetic injections and long-term safety in athletes.

Is it safe?

Happy Autumn 2018 (or Spring, if you are one of our readers from below the equator). It’s that time for another edition of the Clinical Journal of Sports Medicine Online Journal Club, with our regular contributor,  Jason L Zaremski, MD, CAQSM, FACSM, FAAPMR.  The subject of today’s post is one of the original research articles highlighted in our September 2018 thematic issue on pain control in athletes.

Title: Sebak S; Orchard JW; Golding LD; Steet, E; Brennan SA; Ibrahim A. Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications. 

 

Introduction:  The fall Journal Club commentary for the Clinical Journal of Sports Medicine (CJSM) will be an analysis of research examining the perceived side effects and long term safety of local anesthetic injections in professional rugby players over a 6 year period. Local anesthetics are a treatment modality used to reduce or eliminate pain in injured professional athletes with the goal of expedited return to play. Pain control and appropriate ­pharmacological interventions are a current hot topic not only in sports medicine but in all of medicine and society.  Consequently, this study by Sebak et al. in the September issue of the CJSM is a very interesting, time appropriate, and novel contribution to the literature of treatment options for pain control. We thank our colleagues in Australia for a wonderful contribution to the CJSM and sports medicine literature.

Hypothesis: The authors hypothesize that local anesthetic injections are reasonably safe. They predict that data from this study will reinforce the results of a previous similar study with similar authors from 1998-2007.

Dr. Jason Zaremski, Jr. Assoc. Editor of CJSM, and author of the CJSM Blog Online Journal Club posts

Methods/Design:  This was a retrospective case series evaluating the long term safety of local anesthetic injections before or during games involving professional rugby league players. The participants included players from the Sydney Roosters, a member of Australia’s National Rugby League (NRL), from 2008-2013. Read more of this post

“got pain?” Get the new issue of CJSM

A tibial spine avulsion fracture — an injury requiring surgery, and significant pain management.

The new academic year has begun in North America, and with it a new set of sporting seasons and a surge in sports’ injuries in our clinics.  Youth and school soccer and football provide many of the injured patients I manage.  For instance, a few days ago, on a Friday, I saw a 12-year-old boy who described a twisting injury to his knee, with immediate disability and an effusion.  I saw him in my clinic the day after his injury and discovered he had sustained a tibial spine avulsion fracture.

These injuries typically occur in skeletally immature patients aged 8 to 14 who sustain twisting or valgus moments to a hyperextended knee.  Though relatively uncommon, a tibial spine avulsion fracture is seen rather often in a specialty center like mine that focuses on the care of the pediatric and adolescent athlete.

In the USA (perhaps everywhere?), these will almost always require surgical fixation.  Since I am a primary care sports medicine physician, this means I was on the phone immediately with my orthopedic surgical colleague, and the child was booked for the OR on Monday.

What remained for me to deal with were the important issues of splinting and pain management over the weekend.

Pain management in the injured athlete — a broad topic which challenges a clinician on an almost daily basis.  I would add that I have found the issue has become increasingly challenging with the opioid epidemic that has ravaged the USA, most especially in states like Ohio, where I practice.

Over the nearly 25 years I have been a physician, I have seen the conversation about analgesia change from one putting an emphasis on ‘pain as a vital sign’ to one asking the question:  in the physician’s efforts to alleviate pain, has patient safety been compromised?

(L to R) Three greats from South Africa: Martin Schwellnus, Wayne Derman, Pierre Viviers

It is an ever-timely contribution, then, that our September 2018 issue is a thematic issue devoted to the topic of pain management in the athlete.  I am delighted to add that our Guest Editor this month is Professor Wayne Derman who is Director and Chair of the Institute of Sport and Exercise Medicine at the Division of Orthopaedic Surgery, Stellenbosch University, Cape Town, South Africa.

I count Wayne as a friend, and I am happy to let you know I plan to conduct a podcast with him in the next month so you can hear directly from our guest editor how he brought this issue together.

In the meantime I urge you to go to this issue  and check out the many interesting articles, ranging from the excellent editorial about ‘deromanticising’ the image of athletic pain authored by Prof. Derman to the open access study on Cannabis and the Health and Performance of the Elite Athlete.

 

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