The prevalence and perceptions of non-steroidal anti-inflammatory drug use among ultra-endurance runners

Cole, PL, Bontemps, B, Pugh, J ORCID: 0000-0002-5930-4709 and Owens, DJ ORCID: 0000-0002-1908-8677 (2025) The prevalence and perceptions of non-steroidal anti-inflammatory drug use among ultra-endurance runners. Research in Sports Medicine, 34 (3). pp. 257-275. ISSN 1543-8627

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Abstract

Ultra-endurance running imposes extreme physical demands often resulting in exercise-induced muscle damage (EIMD), pain, and inflammation. Many athletes use non-steroidal anti-inflammatory drugs (NSAIDs) despite safety concerns, questionable efficacy, and recent bans in some events. However, the prevalence, patterns, and cultural drivers of NSAID use across performance levels remain underexplored. This mixed-methods, cross-sectional survey included 167 ultra-endurance runners across five self-reported performance tiers. The survey, developed iteratively with expert input, captured NSAID usage during training and competition, motivations, perceived risks/benefits, information sources, and openness to alternatives. Quantitative data were analysed descriptively; qualitative responses underwent inductive thematic analysis. Over half (53%) reported NSAID use, with ibuprofen most common. Usage patterns varied by calibre; Tier 5 (World-class) athletes described strategic use, while lower tiers reported more reactive use. Despite 77% being aware of potential harms, most often renal and gastrointestinal (GI), usage remained high due to perceived benefits. Female participants reported use often linked to menstrual or menopause-related discomfort. Information sources were largely informal, reflecting entrenched norms around pain management. Findings highlight the need for targeted behaviour change strategies, sex-informed approaches, and development of safer, evidence-based pain management alternatives in ultra-endurance sport.

Item Type:	Article
Uncontrolled Keywords:	Muscle damage; performance; recovery; pain; ultramarathon; Humans; Anti-Inflammatory Agents, Non-Steroidal; Prevalence; Cross-Sectional Studies; Health Knowledge, Attitudes, Practice; Physical Endurance; Running; Adult; Middle Aged; Female; Male; Young Adult; Athletes; Muscle damage; pain; performance; recovery; ultramarathon; Humans; Female; Cross-Sectional Studies; Anti-Inflammatory Agents, Non-Steroidal; Male; Adult; Running; Middle Aged; Physical Endurance; Athletes; Prevalence; Young Adult; Health Knowledge, Attitudes, Practice; 42 Health Sciences; 4207 Sports Science and Exercise; Chronic Pain; Women's Health; Pain Research; Humans; Female; Cross-Sectional Studies; Anti-Inflammatory Agents, Non-Steroidal; Male; Adult; Running; Middle Aged; Physical Endurance; Athletes; Prevalence; Young Adult; Health Knowledge, Attitudes, Practice; 0913 Mechanical Engineering; 1106 Human Movement and Sports Sciences; Sport Sciences; 4207 Sports science and exercise
Subjects:	H Social Sciences > H Social Sciences (General) R Medicine > RC Internal medicine > RC1200 Sports Medicine
Divisions:	Sport and Exercise Sciences
Publisher:	Taylor and Francis
Date of acceptance:	9 September 2025
Date of first compliant Open Access:	7 August 2026
Date Deposited:	07 Aug 2026 13:44
Last Modified:	07 Aug 2026 13:44
DOI or ID number:	10.1080/15438627.2025.2561040
URI:	https://researchonline.ljmu.ac.uk/id/eprint/29124

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