The Pain Game: Is Toradol Worth the Risk?

With the swirl of controversy surrounding the management – or mismanagement, depending on which side of the fence you’re on – of Robert Griffin III’s knee injury in Washington’s first round playoff loss to Seattle, pain tolerance has become a hot topic in professional sports.

Athletes are either lauded for playing through potentially lifestyle-altering injuries (see: Rivers, Philip – 2008) or denounced for removing themselves from games (see: Cutler, Jay – 2011).

It’s a black and white comparison. Except that when it comes to the treatments that players use to tame the effects of their ailments, the gray area associated with its side effects is plentiful.

toradol 350x350Anti-inflammatory drugs like Toradol have come under fire recently in light of the NFL Players Association filing a grievance in December that states that players were forced to sign waivers as a precondition to receiving Toradol injections. The grievance charges that team-employed physicians repeatedly and indiscriminately prescribed the injections, which are believed to increase the likelihood of serious heart and circulation problems, while also leading to kidney failure and gastrointestinal bleeding. The players association’s suit seeks to nullify any signed waivers related to Toradol and to mandate that team physicians cease requiring players to sign releases as a condition of medical treatment.

According to the NFLPA, “If an NFL Club physician believes a player would be placed at an unacceptable medical risk by using Toradol as part of the care and treatment of an injury, or if the club physician is concerned about the long-term effects of such use, the team’s medical staff should inform the player of that opinion and refuse to administer Toradol.

“The NFL Club physician should not administer Toradol and require that a player sign a waiver of liability before doing so. If, on the other hand, there is no such concern on the part of the club’s medical staff, it should advise the player that the use of Toradol is appropriate.”

Toradol, a brand name for ketorolac, is classified with other nonsteroidal, anti-inflammatory drugs like ibuprofen. However, unlike ibuprofen, Toradol can be injected or taken orally and acts much more quickly. It has been used as a short-term treatment for moderate to severe inflammation and pain, often within emergency rooms, since being approved by the FDA in 1989. Its infiltration into athletics began in the early 1990s. In the two-plus decades since, Toradol has served as a crutch for players who would otherwise be sidelined with injuries.

Former Tennessee Titans receiver Drew Bennett admitted to taking his first Toradol injection during the 2003 season while battling a hamstring injury. “I couldn’t come close to opening up and running full speed,” Bennett told ESPN.com. “I took a Toradol shot, and 15 minutes later I felt no pain.”

Bennett retired six years later, a career elongated by a weekly injection of Toradol prior to every game.

Star players Tony Romo, Ronde Barber and Brian Urlacher consider the pain-numbing agent an on-the-job hazard. Urlacher went as far as comparing it to receiving a flu shot in a 2012 chat with HBO’s Real Sports.

“You drop your pants, you get the alcohol, they give you a shot, put the Band-Aid on, you go out and play,” Urlacher shrugged. “Not that big of a deal.”

The problem is that no one really knows if excessive use of Toradol is or isn’t a big deal. Not much information is available on its long-term risks, but the drug is banned in several European countries because of concerns about potential gastrointestinal issues such as ulcers and surgical bleeding.

Former NFL center Jeremy Newberry stated that he would sometimes see 20 or 30 players lined up before a game to get a shot of the drug, a scene called a pregame “cattle call.” Another NFL source said that figure was exaggerated. Newberry, the former 49er, Raider, Charger and Falcon, said that Toradol “makes you feel like Superman for three hours,” but the soon-to-be 37-year-old is now suffering from Stage 3 kidney failure that physicians believe may be attributed to his use of Toradol.

Alonzo Mourning postulated that his long-term use of anti-inflammatories contributed to a kidney disorder that forced him to prematurely retire from the NBA in 2003. Medical experts, however, have said that pain pills did not cause Mourning’s kidney disease.

Even with the uncertainty of how Toradol can affect a player’s body after he retires, some doctors worry about the short-term injuries that can be compounded when an athlete experiences a diminished pain sensation. For example, if Griffin had been injected with Toradol – which all observers say he was not – would his brain have been tricked into thinking that his knee was okay?

In short, do drugs like Toradol enable players to continue to play, or are they responsible for further, potentially severe, injury?

What’s even more concerning is that use of Toradol can inhibit the formation of blood clots, similar to the way that aspirin is used to inhibit blood clot formation for heart patients or those at a high risk of stroke. To the suddenly concussion-conscious NFL, the repercussions of allowing team physicians to administer such a treatment could be far-reaching.

In 2011, former Pro-Bowler Joe Horn was among 12 plaintiffs that sued the NFL about its concussion policies, specifically alleging that there was widespread pregame use of an anti-inflammatory drug that could put someone with a head injury at increased risk. It’s one of several lawsuits filed against the NFL by past players who say the league did not do enough to protect them from concussions.

The NFL is in a tough spot on the topic. At least six NFL players have committed suicide in the last two years, with most, if not all, believed to have been brought on as the result of repeated concussions.

Earlier this month, it was revealed that former San Diego Chargers linebacker Junior Seau, who killed himself last May, had signs of Chronic Traumatic Encephalopathy in his brain. CTE is a progressive degenerative disease found in athletes and others with a history of repetitive brain trauma.

The recent tragedies have some players reconsidering their chosen professions. Still, many more are blinded by their desire to play the game, money and the competitive nature of the sport.

Players want Toradol because it keeps them on the field. Coaches turn a blind eye to its use because keeping players on the field increases the chances of a team’s winning, thus bolstering the coach’s employment outlook. Physicians, of course, are employed by the teams and evaluated by their ability to keep players active.

In a sport that’s become heavy handed in sanctioning players responsible for helmet-to-helmet collisions, its most effective way to mitigate brain trauma may be to ban the drug that allows them to suit up in the first place.

“We’re a commodity,” Barber said in a 2011 interview with ESPN. “We’re useful only when we’re on the field.”

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