Page 3 of 3 Previous

Continued: NFL and pain: League zeros in on one pain medication

  • Article by: DAN WIEDERER , Star Tribune
  • Last update: August 22, 2012 - 6:31 AM

During a 13-season NFL career, defensive tackle Warren Sapp cherished those days he was close to pain-free, those games he could race onto the field with nothing but adrenaline pumping through his veins.

"I was in the trenches, boss, with contact every time," Sapp recalls. "And trust me, when I was feeling good, it was a great feeling to go into a ballgame without a shot, without a pill, without two Advil. Oh, man. Come on. I wanted it that way."

And when did that exhilarating, pain-free feeling typically wear off?

"About Week 3," Sapp said.

Life in the NFL is frequently an avalanche of pain -- often nagging, sometimes excruciating. To survive, a player's ability to suppress discomfort is mandatory. And often that requires a bit of medicinal magic on game day, the current drug of choice being Toradol, a nonsteroidal, anti-inflammatory drug.

For years, many NFL players have sought Toradol injections the same way college students slam Red Bull when pulling an all-nighter. But the drug, which surfaced in the league in the mid- to late 1990s, has potentially serious side effects that have prompted league officials to take a closer look at its use. According to multiple NFL sources, the league is giving serious consideration to outlawing Toradol, with the wheels in motion to implement a ban that may be put into effect immediately.

The NFL Physicians Society and the NFL Players Association have been pushing for greater restraint with how Toradol is used.

One of the bigger worries is that the drug -- while it is FDA-approved, currently legal in the NFL and functions similarly to Advil or Aleve -- hasn't been studied significantly enough for doctors and players to fully understand the long-term ramifications of overuse.

Complications associated with Toradol misuse include potential kidney failure, liver damage and gastrointestinal bleeding. There's also increased risk of heart attack and stroke.

More troublesome to the NFL is that Toradol inhibits platelet function, creating a danger of brain bleeding for players who suffer head injuries while the drug is in their system. More than 2,100 former players are involved in lawsuits alleging that the league insufficiently responded to concussions and the long-term implications of repeated brain trauma.

Dr. Thom Mayer, the NFLPA's medical director, said that offering Toradol to players who will be exposed to physical trauma "increases the risk of bleeding from that trauma. In addition, due to the anti-inflammatory and analgesic effect of the medication, the question must be raised whether the use of Toradol [also] increases the risk of additional injury."

According to the Food and Drug Administration, Toradol shouldn't be used for longer than five days consecutively. At present, that's not an issue in the NFL, where the drug is used almost exclusively on game days.

But some veteran players request and receive a Toradol injection before every game. That means some players receive 16 to 20 doses of Toradol over a four- to five-month span.

Vikings defensive tackle Kevin Williams said that for several seasons he has tried to take the shot before every game.

"I think a lot of us take it because we're just used to doing it," said Williams, approaching his 32nd birthday and entering his 10th NFL season. "It's a peace-of-mind thing for a lot of guys."

As Mayer suggests, that's evidence that too many players gravitate toward the drug as a preventative measure -- to mask the pain of injuries not yet suffered.

According to Mayer, the NFL Physicians Society Task Force recently drafted updated recommendations for Toradol usage. Those new guidelines sternly warn against the prophylactic use of the drug.

Furthermore, Mayer said, the task force guidelines indicate Toradol is only to be used by players listed on a team's latest injury report.

Said Mayer: "This task force recommendation is important as it, although indirectly, admits that the gratuitous use of Toradol to keep our players on the field is not, and was never, clinically sound."

'Like a sheet of armor'

Toradol was originally developed as a postoperative drug, used primarily to treat moderately severe acute pain. When injected into the bloodstream, it can begin working almost immediately, quelling whatever pain may be present.

That's been ideal for NFL players in need of a quick game-day fix. Equally important, the shot gives many players added confidence that they can perform worry-free, uninhibited by existing pain and able to more easily push through any new injuries that may occur.

"That ability to numb that pain even just a little makes a big difference," said Vikings defensive end Brian Robison.

Twenty-nine years old and heading into his sixth season, Robison said he rarely turns to medication to treat his pain. But sometimes there's little choice.

During his second year with the Vikings in 2008, Robison had arthroscopic surgery on his right knee in late-November, yet was back playing less than two weeks later. As a young and still unproven player, he knew he couldn't afford to stay off the field. So for three games, he said, he took a pregame Toradol shot to ease his discomfort and ensure he could contribute.

Many players request the injection much more frequently.

Former Vikings tight end Jim Kleinsasser, whose 13-year career ended in January, estimates he used Toradol before just about every game he played over his final five seasons.

"I was just getting old, honestly," Kleinsasser said. "There's a certain point in your career where you're going through the pounding of the season and getting through that week of practice and trying to get to that next game day. Toradol is part of what gets you back to playing the way you normally can."

And sometimes that injection can make all the difference. Former NFL star Torry Holt said he only took Toradol a handful of times throughout his 12-season NFL career. His first use came on the afternoon of the Super Bowl in 2000.

Holt was a rookie with the Rams and had separated the acromioclavicular (AC) joint in his right shoulder during St. Louis' NFC Championship Game win. It was the kind of injury, coupled with bruised ribs, that caused pain so severe that Holt admitted he would have considered sitting out several regular-season games.

But the Super Bowl? With little hesitance, Holt asked for and received a Toradol shot.

"I felt like new money," Holt said. "You get that shot and you feel like you're 18, 19 years old. It's like a sheet of armor. I was a new man."

Several hours later, after making seven catches for 109 yards, including a 9-yard touchdown grab, Holt was also a Super Bowl champion with the Rams edging the Titans 23-16.

Everything about the day felt great. Until the Toradol faded.

"It was very, very, very painful once that medication wore off," Holt said. "When you get that Toradol shot, you feel like you have a whole new body on you. At the same time, you're just tearing away at the problem you have. Masking the pain allows you to get through the game. But the pain is still there, and you'll have to deal with it afterwards."

Veterans first

Exact data on the prevalence of Toradol use in the NFL is unavailable, protected by medical confidentiality laws. The Star Tribune interviewed 18 current and former players for this story, and the consensus estimate is that at least 10 players per team per game will receive a Toradol shot before taking the field. That number, players say, can swell toward two dozen players, depending on the time of the season, the age dynamics of the roster and the team's overall health.

Veterans are more likely to need the shot. And often, younger players are even dissuaded from treating their aches and pains with the injection.

Former fullback Tony Richardson said he used Toradol on a weekly basis in-season for his final seven or eight years in the league. That included stints with the Chiefs, Vikings and Jets.

"I've seen trainers tell players straight up, 'Look, you're too young to get a Toradol shot. Get out of here,'" Richardson said. "A young guy with a serious injury might need it. But a young guy [in general]? We wouldn't even let him in the line. It was like, 'Get out of here. You don't need this.'''

Dr. Lawrence Brown, the NFL drug program's administrator, contends it is difficult to make a blanket statement on how much Toradol use is too much, a medical assessment Brown said should be made on a patient-by-patient basis.

That deflects much of the responsibility toward team physicians and the players themselves. And players, often not knowing any better, will frequently steer toward the treatment that gets them back on the field as quickly and pain-free as possible.

Former Vikings Chris Walsh and Sean Berton were among 12 former players filing a lawsuit against the NFL last December. In that suit, Toradol is prominently mentioned, with the plaintiffs alleging the drug may have prevented them from feeling concussions they suffered while playing.

"Ask the NFL, ask their lawyers: before these players were given these drugs, were they taken into a room and given a sheet of paper to read what these drugs might do to them and then given the opportunity to say yes or no?'' said former Pro Bowl receiver Joe Horn, one of the 12 players involved in the suit. "If their answer is, 'No, we did not,' then guess what, you are at fault. Simple as that."

Vikings medical personnel say they have taken a proactive approach to educating players on Toradol's benefits and harms. At training camp every summer, head athletic trainer Eric Sugarman delivers a presentation on the drug.

In order to receive a Toradol injection before a game, Vikings players must first receive approval from a team physician. Vikings players are also required to sign a waiver once per season, acknowledging they understand the risks.

Said Sugarman: "We have never told a player of ours he has to use Toradol. Never. Absolutely not. Now if a guy elects to use Toradol for whatever reason, he has to have informed consent."

Education needed

But will NFL players, so driven to make sure they're available to play the next game with the least pain possible, take the time to read and digest the fine print?

In an interview last winter with HBO, Bears linebacker Brian Urlacher said he's always thought of his regular Toradol injections like they were "like a flu shot."

Kevin Williams' rationale for feeling safe about his recurrent Toradol use?

"I don't think if you took it 16 times, it would have an [adverse] affect on you over the long run," he said. "That's my mindset anyway. ... You've got to realize, man, us NFL guys have a very small window to play this game. And you're always wired and talking about playing to the best of your ability and having success while you can. Because you won't have it long. You can't last forever."

Richardson, a former member of the NFL Players Association's executive committee, is pushing for players to receive more education on all pain-related drugs. Over the past half-decade, he points out, the league and its players have become more aggressive with their initiatives to address concussion-related issues.

"We've opened the door for that whole whistleblower deal," Richardson said. "If you see one of your buddies and he's not looking right in the eyes, you need to talk to the doctor and get [your teammate] to the sidelines and sit him down versus allowing guys to play through that. Same with these pain medications. We need more awareness.''

Whether awareness will lead players to change their mindset is a question that awaits an answer.

"As a player, I don't have perspective," Sapp said. "I want to play. I don't know anything other than my team needs me, it's Sunday, it's game day, I've got to play. We're always going to go that way. ... That's all we know. That's the way the game was taught to us from the time we were knee-high to a jackrabbit. That's the way the game was played before us. We need to change it going forward."

  • related content

  • CHART: About Toradol

    Wednesday August 22, 2012

    Toradol, a potent non-steroidal, anti-inflammatory drug (NSAID) first received approval from the Food and Drug Administration in 1989. It was...

  • PULLING BACK THE CURTAIN: For the casual fan, there's plenty that remains unseen

    Wednesday August 22, 2012

    Troubling dangers associated with playing football have come to the surface in recent years as the NFL attempts to heighten...

  • Troubling dangers associated with playing football have come to the surface in recent years as the NFL attempts to heighten...

  • November 3, 2002--- Raymond James Stadium � Tampa, FLTampa Bay Bucca...

  • Minnesota Vikings defensive tackle Kevin Williams.

  • get related content delivered to your inbox

  • manage my email subscriptions


Toronto - LP: D. Hutchison 2 FINAL
NY Yankees - WP: M. Tanaka 5
Washington - WP: S. Strasburg 2 FINAL
Miami - LP: N. Eovaldi 1
NY Mets - WP: J. deGrom 10 FINAL
Atlanta - LP: E. Santana 2
Boston - WP: J. Kelly 3 FINAL
Baltimore - LP: M. Gonzalez 2
Milwaukee - LP: W. Peralta 0 FINAL
Pittsburgh - WP: V. Worley 1
Chicago WSox - WP: J. Danks 10 FINAL
Tampa Bay - LP: N. Karns 5
Cleveland - WP: C. Kluber 7 FINAL
Minnesota - LP: A. Swarzak 2
Detroit - LP: R. Porcello 2 FINAL
Kansas City - WP: J. Guthrie 5
Seattle - LP: H. Iwakuma 3 FINAL
Houston - WP: C. McHugh 8
Los Angeles - WP: C. Perez 8 FINAL
Chicago Cubs - LP: J. Turner 5
Texas - WP: S. Tolleson 2 FINAL
LA Angels - LP: H. Street 1
Philadelphia - LP: M. Gonzalez 6 FINAL
Oakland - WP: S. Doolittle 8
San Francisco - LP: R. Vogelsong 2 FINAL
San Diego - WP: I. Kennedy 8
Arizona - LP: W. Miley 3 FINAL
Colorado - WP: C. Bergman 8
Cincinnati - WP: A. Simon 7 FINAL
St. Louis - LP: L. Lynn 2
San Diego 22 FINAL
Buffalo 10
Dallas 34 FINAL
St. Louis 31
Washington 34 FINAL
Philadelphia 37
Houston 17 FINAL
NY Giants 30
Minnesota 9 FINAL
New Orleans 20
Tennessee 7 FINAL
Cincinnati 33
Baltimore 23 FINAL
Cleveland 21
Green Bay 7 FINAL
Detroit 19
Indianapolis 44 FINAL
Jacksonville 17
Oakland 9 FINAL
New England 16
San Francisco 14 FINAL
Arizona 23
Denver 20 FINAL
Seattle 26
Kansas City 34 FINAL
Miami 15
Pittsburgh 37 FINAL
Carolina 19
Chicago 7:30 PM
NY Jets
NY Giants 9/25/14 7:25 PM
Columbus 4 FINAL
Carolina 3
Buffalo 0 FINAL
Washington 1
St. Louis 3 FINAL
Columbus 4
Calgary 1 FINAL
Edmonton 3
Edmonton 0 FINAL
Calgary 1
Old Dominion 45 FINAL
Rice 42
Troy 0 FINAL
(12) Georgia 66
Georgia Tech 27 FINAL
Virginia Tech 24
Eastern Mich 14 FINAL
(9) Michigan State 73
Iowa 24 FINAL
Pittsburgh 20
Bowling Green 17 FINAL
(19) Wisconsin 68
Maryland 34 FINAL
Syracuse 20
Tulane 13 FINAL
Duke 47
Hawaii 12 FINAL
Colorado 21
Marshall 48 FINAL
Akron 17
North Carolina 41 FINAL
(23) East Carolina 70
Army 21 FINAL
Wake Forest 24
Virginia 33 FINAL
(20) BYU 41
(6) Texas A&M 58 FINAL
Rutgers 31 FINAL
Navy 24
Central Mich 10 FINAL
Kansas 24
Utah 26 FINAL
Michigan 10
Florida 21 FINAL
(3) Alabama 42
Louisville 34 FINAL
Fla Atlantic 19 FINAL
Wyoming 20
Indiana 31 FINAL
Missouri 27
San Jose St 7 FINAL
Minnesota 24
Texas State 35 FINAL
Illinois 42
Massachusetts 7 FINAL
Penn State 48
Georgia State 14 FINAL
Washington 45
Appalachian St 20 FINAL
Southern Miss 21
(14) Miss State 34 FINAL
(17) LSU 29
Northern Ill 14 FINAL
Arkansas 52
Middle Tennessee 17 FINAL
Memphis 36
Utah State 14 FINAL
Arkansas State 21
Miami-Ohio 24 FINAL
Cincinnati 31
Idaho 24 FINAL
Ohio U 36
Ball State 23 FINAL
Toledo 34
(13) So Carolina 48 FINAL
Vanderbilt 34
(4) Oklahoma 45 FINAL
West Virginia 33
Ga Southern 28 FINAL
South Alabama 6
Houston 47
Miami-Florida 31 FINAL
(21) Nebraska 41
New Mexico 38 FINAL
New Mexico St 35
Clemson 17 FINAL
(1) Florida State 23
California 45 FINAL
Arizona 49
San Diego St 7 FINAL
Oregon State 28
(2) Oregon 38 FINAL
Washington St 31
Louisiana 9 FINAL
Boise State 34
Texas Tech 9/25/14 6:30 PM
(24) Oklahoma State
Appalachian St 9/25/14 6:30 PM
Ga Southern
(11) UCLA 9/25/14 9:00 PM
(15) Arizona State
Middle Tennessee 9/26/14 7:00 PM
Old Dominion
Fresno State 9/26/14 7:00 PM
New Mexico
Texas-El Paso 9/27/14 11:00 AM
(25) Kansas State
Tennessee 9/27/14 11:00 AM
(12) Georgia
Vanderbilt 9/27/14 11:00 AM
Wyoming 9/27/14 11:00 AM
(9) Michigan State
Northwestern 9/27/14 11:00 AM
Penn State
TCU 9/27/14 11:00 AM
Iowa 9/27/14 11:00 AM
Tulane 9/27/14 11:00 AM
So Florida 9/27/14 11:00 AM
(19) Wisconsin
Colorado State 9/27/14 11:30 AM
Boston College
Western Mich 9/27/14 11:30 AM
Virginia Tech
Maryland 9/27/14 12:30 PM
Akron 9/27/14 12:30 PM
Bowling Green 9/27/14 2:00 PM
Arkansas 9/27/14 2:30 PM
(6) Texas A&M
Kent State 9/27/14 2:30 PM
Western Ky 9/27/14 2:30 PM
Minnesota 9/27/14 2:30 PM
Wake Forest 9/27/14 2:30 PM
FIU 9/27/14 2:30 PM
(1) Florida State 9/27/14 2:30 PM
NC State
Miami-Ohio 9/27/14 2:30 PM
Colorado 9/27/14 3:00 PM
Louisiana Tech 9/27/14 3:00 PM
(5) Auburn
Texas 9/27/14 3:00 PM
Temple 9/27/14 3:00 PM
(16) Stanford 9/27/14 3:15 PM
TX-San Antonio 9/27/14 4:00 PM
Fla Atlantic
South Alabama 9/27/14 4:00 PM
Cincinnati 9/27/14 5:00 PM
(22) Ohio State
Rice 9/27/14 6:00 PM
Southern Miss
Missouri 9/27/14 6:00 PM
(13) So Carolina
Boise State 9/27/14 6:00 PM
Air Force
North Carolina 9/27/14 6:00 PM
Central Mich 9/27/14 6:00 PM
Troy 9/27/14 6:00 PM
New Mexico St 9/27/14 6:30 PM
(17) LSU
Memphis 9/27/14 6:30 PM
(10) Ole Miss
Duke 9/27/14 6:30 PM
Texas State 9/27/14 7:00 PM
Washington St 9/27/14 7:00 PM
(8) Notre Dame 9/27/14 7:00 PM
(7) Baylor 9/27/14 7:00 PM
Iowa State
UNLV 9/27/14 7:00 PM
San Diego St
Illinois 9/27/14 8:00 PM
(21) Nebraska
Oregon State 9/27/14 9:30 PM
(18) USC
Nevada 9/27/14 9:30 PM
San Jose St
Chivas USA 0 FINAL
Toronto FC 3
Toronto 40 FINAL
Brt Columbia 23
Edmonton 23 FINAL
Hamilton 25
Calgary 15 FINAL
Montreal 31
Ottawa 32 FINAL
Saskatchewan 35
Connect with twitterConnect with facebookConnect with Google+Connect with PinterestConnect with PinterestConnect with RssfeedConnect with email newsletters



Date/Opponent Time W L Score
2014 preseason     
Aug 8 - vs. Oakland 7 pmX10-6
Aug 16 - vs. Arizona 7:30 pmX30-28
Aug 23 - at Kansas City 7 pmX30-12
Aug 28 - at Tennessee 7 pmX19-3
2014 regular season     
Sep 7 - at St. Louis NoonX34-6
Sep 14 - vs. New England NoonX30-7
Sep 21 - at New Orleans Noon
Sep 28 - vs. Atlanta 3:25 pm
Oct 2 - at Green Bay 7:25 pm
Oct 12 - vs. Detroit Noon
Oct 19 - at. Buffalo Noon
Oct 26 - at Tampa Bay Noon
Nov 2 - vs. Washington Noon
Nov 9 - Bye
Nov 16 - at Chicago Noon
Nov. 23 - vs. Green Bay Noon
Nov. 30 - vs. Carolina Noon
Dec 7 - vs. NY Jets Noon
Dec 14 - at Detroit Noon
Dec 21 - at Miami Noon
Dec 28 - vs. Chicago Noon




question of the day

Poll: Grade the Vikings offense

Weekly Question