11/5/2023 0 Comments Endurance insurance loginTo be honest, this is the exact opposite of what I expected: I would have guessed that those who struggle most with managing pain would get the biggest benefit from reducing it. ![]() One interesting wrinkle: riders who scored higher on a psychological test of pain resilience-that is, those who felt they had better ability to regulate their emotions and thoughts about pain-tended to get a bigger performance boost from tramadol. The tramadol riders are pulling ahead right from the first split, and continue to widen their lead throughout the trial. For starters, here are the five-mile splits for the tramadol (open circles) and placebo (closed circles) conditions in the 25-mile time trial: (Illustration: Journal of Applied Physiology) But it’s still an open debate, which makes any new data on the question particularly interesting.Īnd the details of Mauger’s data, it turns out, are indeed curious. There may be ways of reconciling these two views: perhaps the cognitive effort of managing increased pain makes exercise feel more effortful, for example. Staiano and Marcora have published some interesting data supporting their contention that we quit when effort maxes out, even when the pain we’re experiencing is still tolerable. ![]() When I wrote about Mauger’s research on pain in 2020, I noted that other researchers such as Walter Staiano and Samuele Marcora believe that subjective perception of effort (“the struggle to continue against a mounting desire to stop”) is more important than pain (“the conscious sensation of aching and burning in the active muscles”). In Mauger’s view, pain is one of the sensations that causes us to slow down or stop during endurance exercise, so the tramadol results make perfect sense. He has followed up with other studies using various techniques like saline injections to manipulate exercise-associated pain. In 2010, Mauger published some remarkable data showing a 2 percent boost for cyclists taking a simple dose of Tylenol. Still, the new results make a strong case that tramadol boosts performance and should thus be banned. It’s also worth asking whether the benefits of a painkiller might be exaggerated in a test where the subjects are forced to fixate on their own discomfort, giving continuous ratings of exactly how much they’re hurting, compared to the real world. Mauger and his colleagues argue that these previous studies have featured performance tests that weren’t long or hard enough for pain control to matter, failed to exclude participants who had side effects like vomiting from the drug, or muddied the waters by having cyclists complete cognitive tests while they tried to race. Admittedly, previous studies of tramadol’s performance-boosting effects have produced mixed results. WADA’s rules require that a substance fulfill two of three conditions to be banned: it enhances performance, has the potential to harm the athlete, and violates the spirit of sport. The riders were, on average, 1.3 percent faster in a 25-mile time trial when taking tramadol. A group led by Alexis Mauger of the University of Kent in Britain put 27 highly trained cyclists through a series of performance tests with either 100 milligrams of tramadol (a modest dose: Kirkland was taking as much as 20 times that amount at once) or a taste-matched placebo. ![]() The data that finally changed WADA’s mind has now been published in the Journal of Applied Physiology, where it’s free to read. The International Cycling Union banned it in 2019, but WADA continued to take a wait-and-see approach. For some athletes, like British soccer goalkeeper Chris Kirkland, tramadol was a gateway to full-blown opioid addiction. ![]() WADA testing in 2017 found tramadol in 4.4 percent of all samples from cyclists, leading to worries that tramadol-addled riders would cause crashes in the peloton. “It kills the pain in your legs, and you can push really hard,” former Team Sky rider Michael Barry claimed. It’s been a long time coming: the abuse of tramadol has been an open secret in cycling, with rumors swirling about its use by Team Sky and British Cycling. On January 1, 2024, a new World Anti-Doping Agency rule will kick in that officially bans tramadol, an opioid painkiller.
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