Super Bowl Blues

The 2018 – 19 NFL season has ended with a familiar conclusion:  the New England Patriots having won (their sixth such championship).

Are you among the people who watched the game and found it boring (‘worst ever’)*?  Did you forego viewing entirely? Are you among the majority (reportedly) of fans disappointed because those Patriots won?  Sad simply because the season is over?

February can be a slog for all of us in the Northern Hemisphere — sports like the NFL can keep us going, and so perhaps you, my dear reader, are a bit blue for any number of reasons?

Well, I do not have something to cheer you up per se — rather I have something, perhaps, that will make you more blue….but it is an issue of vital importance to our profession.  And we can’t turn our eyes askance.

Recently published ‘ahead of print’ is headline-making original research: Reasons for Prescription Opioid Use While Playing in the National Football League as Risk Factors for Current Use and Misuse Among Former Players.

Headlines indeed. Over the Super Bowl weekend the New York Times published an article profiling former NFL players and their struggle with chronic pain and opioid addiction. It referenced the CJSM study authored by Dr. Eugene Dunne of Brown University and his team of authors.  Some of the more important findings reported are that among “….retired NFL players with exposure to prescribed pain medication during their playing career 26.2% reported recent use of prescription opioids (past 30 days).”  Moreover, the authors found that the past may be midwife to the future: use of opioids to manage pain during their career was associated with a 30% increased risk of present-day use of opioids in retired NFL Players.

Opioid use and abuse is a public health crisis of unprecedented scale in the USA according to JAMA.  Sports are not untouched by this epidemic.  CJSM has always striven to publish important and relevant research which can be translated into practical use — we provide this platform for clinicians helping individual patient-athletes, and we provide this platform for public health advocates as well.  We devoted an entire issue (Sept 2018) recently to the oft-neglected subject of pain management in athletes.  Guest Editor Prof. Wayne Derman of Stellenbosch Univ., South Africa emphasized in our podcast with him that it is imperative that clinicians seek holistic methods of pain control and that researchers look more intentionally at the issue of analgesia in athletics. An over-reliance on pharmacology, most especially opioids, is a potential recipe for problems (to wit, the experience of former NFL players in this new CJSM study).

Join us in this work and the global conversation on issues of importance to athletes, clinicians, researchers and public health advocates by checking out some of these references and following us on Twitter. We’ll always keep you abreast of what’s new and breaking in our world of sport and exercise medicine.

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*P.S. I really enjoyed the Super Bowl. Though low scoring, I loved watching Pats’ defense flummox such a great Rams’ offense, and I thought the game was tense until the very end. How about you?

Concussions: The “Injury of 2018”

Concussions remain a dominant subject in the sport medicine literature and media at large — Photo: PET Scan Brain, Wikimedia

As 2018 winds down, the Clinical Journal of Sport Medicine, like so many of its sister media, finds itself in a reflective mood.

Time magazine, for instance, has just named its “Person of the Year”: a group of journalists the magazine notes has been ‘targeted’ for the work they do pursuing the truth.  Time calls them The Guardians. It is an interesting selection:  a media outlet honoring other professionals in its own line of work.

I thought it time that CJSM do its own version of “Person of the Year,” but with a sport medicine twist — Injury of the Year.

I’m naming “Concussion” the Injury of the Year.  In 2019, I’ll have my ‘act together’ and put out a Twitter poll in late November for reader contributions; but in 2018, I’ll have to play judge and jury, given that it’s nearly mid-December. Thanks for indulging me!

Like LeBron James of the NBA, who could probably be named MVP in any year he has played in the league, concussion is a sports injury which could probably earn this distinction in any year over the last decade or more.

In truth, 2018 was a red banner year for the injury, so to speak.  As an example, nearly our entire March 2018 issue was devoted to original research on various aspects of the subject, including a systematic review on the long-term consequences of traumatic brain injury in professional football players.  Continuing this line of reasoning, I would draw your attention to another noteworthy systematic review just published in our last issue of 2018 (November).   This one looks at the utility of blood biomarkers in the assessment of sports-related concussions (spoiler alert:  we have a long way to go in developing these for ‘prime time’).

The dominant theme of our 2018 podcasts was, again, concussion.  Read more of this post

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.

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

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