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The NFL’s Problem with Pain: Part One

For professional football players, injury is inevitable. But has the NFL been dealing with pain the wrong way?

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Playing football is a brutal past time. Boasting nearly a 100% injury rate coupled with some of the lowest median salaries of any major American professional sport, NFL players often retire with the most chronic injuries and the least amount of cash in the bank to show for it. For players that make it to the professional level, it’s not a question of "if" you get hurt, but rather "when".

Contrary to professional baseball and basketball contracts, professional football contracts are not fully guaranteed and often hide a litany of guarantee reducing tactics. For instance, if a player is punished under the NFL personal conduct policy, their guaranteed salary can be declined by the team. Players are therefore constantly working hard to keep their current contract intact (ie. not being forced to restructure) or establishing a body of work to help them cash in on their next future contract.

Because the end of a player’s career is literally "one hit away," every OTA, training camp practice, seasonal practice, and game played can be a player’s last. If a player begins to appear "injury-prone," he is in serious danger of being cut by the team. And because every single player in the NFL is injured at some time to some degree, those who are able to mask or fight through the pain and continue playing are more likely to remain employed than those who can not maintain their availability.

Here’s where the nature of the NFL as a tough man’s league literally butts heads with the notion of player safety and proper pain management. There is an onus on both the player and team doctor to keep that player in the game. The player wants to continue so he can earn his living and maintain his value to his team. The doctor’s job is to keep the best players on the field no matter how injured they are. Obviously the professionally precarious position of both parties presents a clear conflict of interest.

While the sport remains about dangerous as it always has been, player awareness surrounding those dangers has increased tremendously in recent years. NFL players are beginning to retire younger and younger while citing their fears of future physical and cognitive disabilities as the main catalyst for their decision to walk away from a sport they have loved. Chris Borland, Calvin Johnson, and most recently Eugene Monroe have all retired long before the ancient motto "Ball till you Fall" took hold.

Soon after announcing their retirements, Johnson and Monroe both spoke candidly about the problems with pain medication usage in NFL locker rooms. Vicodin and Toradol were administered "like candy" according to Johnson, especially in his earlier pro seasons. One season, he took as many as two Vicodin per game and had his knee drained over 20 times.

Monroe spoke eloquently in his latest article from the Player’s Tribune on the problem with pain management techniques in the NFL. He described a pain treatment culture that fosters abuse and addiction. "I don’t want to have to continue to consume pills to do that; I don’t want to do that," he said. "Anti-inflammatories or opioids, which I certainly don’t want to take, that is certainly the option to stay within the rules of the game."

But when it comes to following the rules of regulation over controlled medical substances, the NFL couldn’t be more of a laughing hypocrite. "Only a doctor who is a registrant with the Drug Enforcement Administration can dispense prescription pain medication," says Rusty Payne, a DEA spokesman. Yet 63% of the former players interviewed by ESPN admitted they were able to acquire pain medication from non medical personnel including trainers, coaches, teammates, family members, the Internet and drug dealers.

Former Saints offensive lineman Kyle Turley, who was one of the 644 participants in the ESPN study said, "I know guys that have bought thousands of pills. Tons of guys would take Vicodin before a game." Obviously misuse is rampant during a player’s career, but, especially after retirement, that player’s high risk for misuse remains.

Retired Dolphins tight end Dan Johnson injured his back while playing, had two back surgeries, and then became addicted to the painkillers prescribed to him following those surgeries. "I was taking about a thousand Vicodins a month," he said. "You know, people go ‘That’s impossible. You’re crazy.’ No, that was exactly what I was taking."

Washington University has been conducting a fascinating study on prescription pain medication misuse and addiction specifically within the retired football player population. Among their many troubling findings is the common theme that players began taking a medication for one reason but needed to continue taking the medication for other reasons as time wore on. Eventually, many players simply could not function without consistent continued use of pain medication.

While Toradol is not known to have addictive properties, pain meds like Vicodin and OxyContin are highly addictive as they belong to the same medical family as heroin. Their increased use in the US over the last fifteen years has directly lead to a severe increase in overdose related deaths. According to the Centers for Disease Control and Prevention, in 2014 alone, the US has seen a four-fold increase in opioid overdoses with 28,647 people killed. Since 1999, over 190,000 Americans have died from opioid overdoses.

Because football players sustain injuries at a vastly higher rate than most other populations, their propensity to use, and then misuse pain medication is also much higher. In fact, the ESPN study of 644 retired NFL players found they were three times more likely to abuse prescription painkillers than the average person. 52% of the players admitted to using prescription pain medication during their careers. Of those, 71% reported misusing medication during their career and 15% of the misusers admitted to misusing the medication within the past 30 days.

It’s clear, the NFL has a problem with pain and it’s not going away. Next week, I will present possibly the safest and most effective alternative medication for dealing with chronic pain along with a plethora of other maladies including head trauma. I just hope the NFL is willing to listen and make a conscious shift in how it deals with the greatest inevitabilities in professional football, injury and pain.