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Just Say No to Ibuprofen and Some Pain Management Alternatives… Including an “Adult” Solution

Posted by on Jun 5, 2011 | 11 Comments

Yesterday I had the opportunity to volunteer at an aid station for the inaugural Yankee Springs Trail Run in Middleville, Michigan.  I was there all day, so I was able to observe a lot of behaviors.  The weather was hot and humid (approaching 90° midday.)  There were three distances- a half marathon, marathon, and double marathon.

I was shocked at the number of runners that were popping ibuprofen during the race, especially the marathon and double.  Many of the people taking ibuprofen also complained about dehydration.

I was immediately reminded of the story of Erik Skaggs.  During the Where’s Waldo 100k a few years back, Skaggs took ibuprofen because of a hamstring injury.  He won the race, but spent the next week or two in the hospital suffering from acute renal failure.  His doctors attributed his kidney failure to a combination of dehydration and ibuprofen use.

Trail Runner magazine wrote a great article on the issue.

The issue is probably more relevant in longer-distance events as runners attempt to relieve some of the pain generated by running for hours on end.  The Trail Runner article mentions a poll done at Western States that found no difference in perceived pain between people using and not using NSAIDS (non-steroidal anti-inflammatory drugs… which includes  ibuprofen.)

Running long distances usually hurts, and the pain increases as intensity increases.  It is VERY tempting to do something to dull that pain.

[Warning, I’m getting on my soapbox]

Here’s my take- if you need a drug to dull the pain, you shouldn’t be running that distance at that intensity.  Pain is adaptive.  It alerts us to injury.  A critical skill runners should develop is the ability to discriminate between “injury pain” and “I’ve been running for a long time, but this pain isn’t an acute injury” pain.  Taking a shortcut here is inviting injury.  Learn to listen to your body.

Once you develop this discrimination ability, work on pain management strategies that do not rely on possibly dangerous drugs.  That “I’ve been running for a long time, but this pain isn’t an acute injury” pain is part of running long distances.  I’ve experienced it many times.  In the beginning, I was really bad at managing it.  It would consume my thoughts and became an obsessive focus.  Over time, I developed skills to deal with it.  Pain is simply your brain perceiving incoming signals from sensory neurons throughout your body.  As such, we have some control over how we perceive pain.  All of my techniques are based on this principle.

Disclaimer- if you experience pain, see your doctor.  You may be hurt.  I am not a medical professional.  The following suggestions are not meant to substitute sound medical advice.  They are intended for informational purposes only.

Here are some of the things I use:

  • Distraction- This is the easiest to learn.  We’re not good multi-taskers.  If you feel pain but give your brain something else to do, our perception of pain is reduced.  Talk to other runners.  Imagine your next vacation.  Picture your significant other nude.  Better yet, have them run in front of you and “set the pace” (I wonder if Shelly is reading this…)  Anything you can do to take your mind off the pain will reduce the perceived intensity.
  • Relaxation- Reducing anxiety will reduce our perception of pain.  As a barefoot runner, I routinely practice relaxation to maintain fluid, easy form.  The great side effect of this relaxation- it dramatically reduces pain perception.  I’ve noticed many runners run with a lot of tension in their shoulders and upper body.  That tension makes pain perception more intense.  Try consciously relaxing as many muscle groups as possible.
  • Speed up for short bursts- Use this one judiciously.  Speeding up will cause you to use slightly different muscles, which will reduce the workload on your overworked (and painful) muscles.  This temporary reprieve can make a significant difference in perceived pain.
  • Embrace the pain- Simply acknowledging you’re experiencing pain and knowing you will continue to be in pain can be incredibly effective.  The exact method to accomplish this is difficult to explain, but I use a self-talk mantra.  I repeat “I am in pain.  My [insert most painful body part here] hurts.  I am okay with that.  I accept the pain as part of the experience.”  Doing this seemingly transforms the painful stimuli (running) from an aversive experience to a neutral experience.  Remember, pain is just a perception.
  • Become a masochist- By definition, a masochist is someone that derives gratification from pain.  I think most ultrarunners eventually become masochists… we like the pain.  I think we develop this by repeatedly pairing the positive benefits and experiences of ultras with the pain, thus making the pain almost enjoyable.  Since this is a fairly long discussion, I’m continuing it outside the bulleted list

Using Classical Conditioning to Become a Masochist

Is there a shortcut?  Maybe.  You can utilize good ‘ole classical conditioning for this (remember Pavlov’s salivating dogs?)  To learn to like pain, we’re going to use a concept known as higher-order conditioning.  We’re going to create a conditional stimulus that produces a good feeling, then pair that conditional stimulus with the pain of long-distance running.  You will also need an iPod or other mp3 player and some songs you enjoy but won’t likely hear on the radio and at least some alone time once a day for a week or two (or more.)

WARNING:  The following discussion involves topics that may be considered adult in nature.  Use appropriate discretion at work or around kids.  Also, it helps if you’re open-minded and adventurous.  If you are easily offended or especially prudish, you may want to skip the following.  This deals with a touchy subject.  For your convenience, I highlighted this section in dark blue.

The idea works like this.  We’re going to pair something pleasurable with the songs you selected.  After multiple pairings, the pleasurable stimulus can be removed.  Whenever we hear the songs, we’ll experience the same pleasurable feelings.  We then listen to those particular songs when we first experience pain during a run.  After multiple pairings of the songs and the pain, we will transfer the pleasure of the songs to the experience of pain.  The result- you become a masochist! Yipee!

  • Step 1- select three to five songs that you will not likely hear anywhere else.  Here’s a chance to support your local garage bands.  The need for obscure songs will be explained later.  Load songs on your favorite portable music device.
  • Step 2a- find some alone time.  Get your iPod or MP3 player set up.  Now while listening to the music, masturbate to orgasm.  Yeah, you read that right.  Rub one off to the music.  Do this as often as you like.  The more often, the better.  The point is to develop an unconscious association between those specific songs and the pleasure of masturbation and subsequent orgasm.  The exact number of pairings is difficult to estimate, but 5-10 should do the trick.  The more, the better.  Some people may be temped to include a partner.  This can work, but you will probably associate some of the pleasure to them and not the music.  I’d recommend flying solo for this mission.
  • Step 2b- Make sure you don’t accidentally listen to the music in any other situation.  First, it will corrupt the association you’re trying to build.  Second, the songs will probably result in some degree of involuntary arousal, especially if you’re not exercising.  I’ll let you imagine the potentially embarrassing situations.  :-)
  • Step 3- Determine if association is learned.  After five to ten pairings, listen to the music without masturbating.  How does it make you feel?  The music should cause a release of dopamine in your brain, which will make you feel pretty good (and probably aroused.)  If so, congratulations!  If not, you need more pairings.
  • Step 4- Once you learn the association, go for a long run.  There are two important points- don’t listen to the music until significant pain sets in later in the run.  Other music is okay, but save the “special” songs.  Second, the run has to be long enough to cause significant “I’ve been running for a long time” pain.  Once you get to the point where the pain is difficult to manage, listen to your songs.  You should immediately feel better.  Maybe even a little aroused.  Both are good.  Continue for the duration of the four or five songs.
  • Step 5- repeat both pairings often.  Listen to the “special” songs while masturbating.  Listen to the “special” songs while experiencing the long run pain.  Over time, you will begin to associate the long run pain with pleasure of the songs to the point where the pain itself will bring a degree of pleasure.  Congratulations, you’re a masochist!

Additional points- It’s important to only listen to your special songs while masturbating or reaching the painful part of the long runs.  Additionally, you may want to do those long runs alone until you can assess the degree of arousal the songs will cause.  Of course, feel free to bring your significant other along, but I cannot be held responsible for any legal trouble you encounter for engaging in an off-trail quickie.  Lastly, some degree of generalization will occur.  You may experience these effects to a lesser degree when listening to similar music other than your “special” songs.  Also, you may experience the pleasure effect when doing any physical activity.  You’re essentially developing a fetish for long-distance running.  Proceed with caution.

There you have it.  Here are some great methods to manage the pain of long runs without having to rely on possibly dangerous or even fatal drugs.  Leave the “Vitamin I” (ibuprofen) at home.  There are safer, more effective ways of surviving your long training runs and races.

Against my better judgement, I’m going to ask for your experiences with these methods.  Do you use any ibuprofen-substitutes now?  How do you handle the pain of long runs?  Are you going to try any of my methods?  If so, let us know how it goes.  ;-)

 

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11 Comments

  1. Jocelyn
    June 8, 2011

    *loads 70s porn music onto ipod*
    ♪♫ bow chicka bow bow ♪♫

  2. Rob
    June 7, 2011

    For normal training I never use vitamin-I, but if I’m in the throws, late in a long ultra-marathon and I need something to take the edge off a bit? Then yes, I may pop a couple pills, seriously no harm in that. Works every time to take the edge off and I can state unequivocally that it’s helped my end-game performance. I think the keys are: 1) Don’t over medicate during a race, I think this is the area that Skaggs got in trouble with (as well as some other competitive ultrarunners I know) 2) MUST be hydrating enough during the race other wise you really are setting yourself up for renal failure! 3) Laying off the vitamin-I in training ensures you don’t build a dependence or tolerance and so fewer pills pack a bigger punch when you REALLY need them. That being said, I’ve raced long mountain 100s w/o any medications and finished well, just depends on the day…

  3. Jen
    June 6, 2011

    This is great. I won’t use vitamin I for the very reasons that you said. I want to know when something is hurting so that I don’t screw something up later on.
    I used a similar technique to help me remember form while on the run and thought of Pavlov as well. If you get time, check it out. It’s not nearly as much fun as yours though.
    http://jenintraining.blogspot.com/2011/03/pavlovs-dog-conditioning-theory-for.html

  4. Kevin
    June 6, 2011

    Beer.

  5. Ryan
    June 6, 2011

    I wonder when it would be safe to take it after a race to help with the discomfort, mostly for sleeping? Thats when I find its hardest to ignore the pain. Any tips or advice?

  6. Susanna
    June 6, 2011

    I’ve used the distraction and relaxation methods long before I started running. Distraction works well when getting a tattoo and relaxation on a dentist. =)

    I actually distract myself too easily when I’m running. Some of the time I listen to the music that I always have on while running, but most of the time I’m just not present. Not really a good thing if traffic is heavy..

  7. Martin
    June 5, 2011

    First of all I’d like to thank you Jason for your book, it encouraged me to run barefoot, and I’m enjoying it a lot.
    The post is great as always, and very entertaining, as all of your posts.
    About painkillers one story comes to my mind: One day, a friend of mine had pain in her belly, so she popped some painkillers, I think it was mefenamic acid, a really strong one. Then she thought putting a hot-water bag on her belly would do her good. She ended up having a sunburn-like burnt belly, I saw it for myself, the skin was really red…
    It is self evident that painkillers are no good before an activity that is able to hurt you.

  8. Vanessa
    June 5, 2011

    Off-trail quickie vs popping a pill? No brainer.

  9. Chris
    June 5, 2011

    I like your distinction between acute “pain” and I’ve been running a long time “pain.” I think of them as pain and discomfort. When I ran my last marathon, so many friends and family gave me comments like: pain is just weakness leaving your body. My reply was: discomfort is weakness leaving your body, pain is your body’s way of telling you are doing something wrong.

  10. Ben S
    June 5, 2011

    First, THANKYOU to you and all the other volunteers at the race. Your help was greatly appreciated! The second lap was very painful. I remembered another runners advice to just keep putting one foot in front of the other one step at a time. Distraction was also a big help. I ordinarily hate flies, however, one particularly big one kept following me buzzing around my head the second lap. I eventually called him Larry. The presence of Larry the superfly was actually a source of comfort in the final miles.

  11. Janice Nicholls
    June 5, 2011

    I used to take Ibuprofen before running because my knee hurt. That resulted in masking the pain enough that I could run. The end result, I ran through ‘bad pain’ and was off for a year awaiting knee surgery. That was also when I wore shoes. Now I never take Ibuprofen before running — I need to have a clear read on any pain. I also run barefoot. Despite my surgeon telling me I should never run again, I’m running well and enjoying it. Pain free:)