Pain Management in Athletes: A Conversation with South Africa’s Wayne Derman

Wayne E. Derman MBChB BSc (Med)(Hon) PhD, of Stellenbosch University, South Africa

Our guest for our newest podcast is Wayne E. Derman MBChB BSc (Med)(Hon) PhD.

Dr. Derman was the Guest Editor of our September 2018 CJSM, which was a thematic issue focusing on pain management in athletes.  He hails from South Africa, where he is Director and Chair of the Institute of Sport and Exercise Medicine, at the Division of Orthopaedic Surgery, Stellenbosch University. Dr. Derman does research in Sports Medicine, Rehabilitation Medicine and Cardiology and lectures widely around the world.

If you have not heard him speak, now is your chance. We had an exciting discussion about the challenges of pain management (and the challenges of guest editorship) which we have entitled:

No pain no gain? NO WAY!

Take a listen to this episode, and all of our podcasts, at the CJSM link on iTunes or on the journal’s home page on the web.  Then consider reading Dr. Derman’s lead editorial, or any number of the published studies in the thematic issue, and share your thoughts which him or us on Twitter: @wderman @cjsmonline.

Open Water Swimming

IMG_1459

Sunrise over Lac St. Jean, site of FINA 10K and 32K open water swimming events

Amazing to think that the Rio Olympics opening ceremony takes place a mere week from now.

I am, currently, enjoying the good fortune of mixing with Olympians from several countries who will be headed there for the open water swim events.  This weekend I am in Roberval, Canada (3 hours north of Quebec City), at Lac St. Jean — where the FINA/HOSA 10K marathon World Cup and 32K Gran Prix events are taking place.

I am a FINA medical delegate at these events.  I have written about this experience before in a 2013 blog post:  the 32K Gran Prix event coincides with an historic open water swim that has been done for decades on this lake, the Traversee internationale du lac St-Jean.

It is a great pleasure to be involved in an international sporting event like this one.  The local organizing committee does fabulous work.  I am privileged to work with fellow FINA representatives from New Zealand and France. Outside of the work hours, we get to socialize some and partake in the hospitality of the Roberval community.

I also greatly enjoy working for the athletes, watching out for their health and safety.  I genuinely enjoy getting to know them and experience vicariously the thrill of their competition. The joy and challenges of sport are a special dimension of human culture —  I am sure this is what leads many of us to sports medicine.

I think it is those broader, aspirational aspects of sport that lead many of us in the sport medicine community to push back on efforts toIMG_2210 cheat, such as doping.  And it’s no surprise that for an elite, international event like this one FINA has doping surveillance as part of its core mission.  One of the roles I play during my time on site is to supervise the excellent work done by representatives of the Canadian Centre for Ethics in Sport, which conducts post-race testing on select individuals many of whom, as I have indicated, will be swimming soon in Rio, where we already have had headline-making doping news before the games have even begun!

We have published frequently on the issue of doping in the pages of CJSM and these blog pages.  We hope you take this chance to click on those links and look at some of that work, in advance of the upcoming Olympics.  And, since it’s Friday, it’s time to follow something new — I would suggest the Facebook page of FINA, which is so well done, and will be hopping with information about this weekend’s Traversee and next month’s Olympics.

Enjoy the Games!  Let them be competitive, safe, and clean.

Dietary Supplements in Sports

2004_TX_Proof

Texas — site of upcoming AMSSM annual meeting [Dallas, 4/15 – 4/20]

One of the studies in our March 2016 CJSM which has generated substantial interest is original research from the Department of Military and Emergency Medicine, Uniformed Services University of the USA: “Dietary Supplements: Knowledge and Adverse Event Reporting among American Medical Society for Sports Medicine (AMSSM) Physicians.

The AMSSM, one of our affiliated societies, is having its annual meeting coming up in Dallas April 15 – 20, and we’re looking forward to joining in those proceedings [the official hashtag of the meeting is #AMSSM16 — keep that in mind you Twitter folks].  The physician membership is not infrequently surveyed about a variety of matters of interest to practicing sports medicine clinicians; the results of these surveys often provide invaluable data to researchers who have published in the CJSM pages.

Examples of this include “Concussion Practice Management Patterns among Sports Medicine Physicians” and “Cardiovascular Preparticipation Screening Practices of College Team Physicians.” 

Regarding the study on dietary supplements (DS), the authors looked at a variety of issues.  Of note, they found that majority of survey respondents (71%) reported that athletes under their care had experienced an adverse event associated DS use.

Not all of us who read this blog or subscribe to the journal are AMSSM members, of course, and so I thought it might be time for a poll, asking this very question: have you ever taken care of an athlete who has experienced an adverse DS event?  Please, take the poll, and if you can, send us a comment on this blog identifying the DS, the adverse outcome, and possibly the sport in which your athlete was participating.

We hope to see you in Dallas!

A Sharapova Moment

The world of sports medicine is never boring, but who knew things could get this interesting?

In the first weeks of March, there have been at least two major stories that have transcended the borders of ‘sports medicine’ and become topics of debate for the world at large — I speak of the proposed ban on tackling in schoolboy rugby (and the continued debate on tackling in American football) and Maria Sharapova’s admission that she failed a drug test at the recent Australian Open.  For both stories, the boundaries of the discussion have gone well beyond the lines of the playing fields and the walls of the academy.

Social media has seen these topics trending. The mainstream media have been profiling the issues as well.  The Economist weighed in on the debate about tackling. And this morning I found the New York Times prominently featuring Ms. Sharapova’s story, including articles on the drug meldonium [for which Sharapova tested positive] and on the issue of the World Anti-doping Agency’s (WADA) use of emails to notify individuals about changes on WADA’s banned substance list.

Many people have an opinion on the subjects.   We’ve been running a poll on this blog regarding the issue of tackling, while our friends at the British Journal of Sports Medicine (BJSM) have been running a Twitter poll on the Sharapova issue: who is responsible, the player or her support staff [currently the poll is 74%/26% stating it’s the athlete’s responsibility].

In the New York Times article and in the BBC, former WADA-president Dick Pound has stated his opinion that Sharapova’s failed drug test was ‘reckless beyond description.’

I must say I take issue with this and empathize with Ms. Sharapova, who stated that she received in December the WADA email noting that meldonium was now on the banned substance list, but “…I did not look at that list.”  Meldonium was a PED legal until 2016, when it was placed on the ‘banned substances list.’ As a professional inundated with emails, alerts, pronouncements, and more, I confess to a certain degree of information overload even when it comes even to items vital to my licensure and ability to practice.  Have I ever received an email from the Medical Board that I have deleted?  Have I ever received notification from my hospital staff office of some new change in policy which I glossed over?  Yes and yes.

Regarding the WADA emails, other athletes in the NY Times article have offered this opinion: “Some dismissed the messages as irrelevant to their own regimens or too complicated to be useful.”  That certainly resonates with me and my professional world.

I am not writing this to absolve Ms. Sharapova, and I applaud her for her prompt and open admission of personal responsibility. That stance is right and proper.  But I would hardly deem her action “reckless beyond description.”

In CJSM we have published over the years several studies on banned substances. One of the pieces of original research just published in our March CJSM sheds some further light on this issue, I think: Dietary Supplements: Knowledge and Adverse Event Reporting Among American Medical Society for Sports Medicine Physicians.  Read more of this post

<span>%d</span> bloggers like this: