Marathon runners and walkers often want to take pain relievers before or during a marathon. You might start off with muscle aches, arthritis pain, or a headache, or develop pain during the race. However, pain relievers may not help you make it to the finish line, and might even hurt you. Learn the risks you face and whether the benefits may be worth it.
Avoid Pain Relievers Before and During the Marathon
Marathon medical directors advise against using any non-steroidal anti-inflammatory pain relievers (NSAIDs) the night before or during the race. They are only safe to take after the finish, and then only after you have urinated once (showing you are not dehydrated and your kidneys are functioning). These medications include Advil, Motrin, Aleve, and ibuprofen.
Pain relievers can cause problems during the marathon. A study of almost 4,000 marathon runners found five times more adverse effects during the race among those who took over-the-counter pain relievers before the race. The most common problem was gastrointestinal upset.
Another study of 89 ultramarathoners found that those who took ibuprofen (400 milligrams every four hours) during a 50-mile race were more likely to have acute kidney injury than those who took placebos.
NSAIDs may not help you during the race in any case. One study found no difference in performance between runners who took ibuprofen for muscle aches and those who took a placebo.
If you regularly take pain relievers for a condition, talk to your doctor about whether you should use them on long training runs and walks and in marathon conditions.
Problems with NSAIDs
The most common over-the-counter non-steroidal anti-inflammatory medications are ibuprofen (Advil) and naproxen sodium (Aleve). They have two effects: pain relief and prevention of inflammation. They can cause nausea and they decrease kidney function. In the marathon study, five racers who took ibuprofen reported they were hospitalized with temporary kidney failure.
While you may not usually have problems with NSAIDs, you are putting your body under extreme conditions for 26.2 miles and you may have an unexpected reaction. You could end up with a race-ending problem.
Problems with Tylenol (Acetaminophen)
Tylenol (acetaminophen) has two effects: pain relief and fever reduction. It can be toxic to the liver when you are overheated and at oxidative stress, as when running or walking a marathon, making it especially concerning for use when you are going to be logging long miles. Some people get nausea from acetaminophen, which is already a common complaint of marathoners.
Your liver takes most of the work of breaking down acetaminophen, and the difference between a therapeutic dose and toxic dose has a narrower range than for the NSAIDs. If you lose track of how much you are taking, you can damage your liver permanently, and an overdose is not treatable.
Marathon medical directors give a very tentative nod to Tylenol if a pain reliever is needed during the race, with good attention to using it only as directed.
Problems with Aspirin
Aspirin has three effects: pain relief, fever reduction, and anti-inflammation. It also inhibits the ability of the blood to clot effectively in most people. This can result in bleeding more if you have an injury, and experts suspect you have more micro-bleeding and burst capillaries from the 26.2 miles of pounding your feet and legs take during a marathon. Many people experience nausea and even gastric bleeding from aspirin. In the large marathon study, four racers who took aspirin reported being hospitalized with bleeds and two with cardiac infarctions.
Many people take low-dose aspirin regularly as recommended by their doctor. You will know how that affects you on your long training runs. Discuss this with your doctor to get advice on your situation.
Alcohol is not advised during a run, especially if you have taken any other pain medication. You may pass some informal beer stops near the end of the race, and quaffing a mug has been anecdotally reported to have a pain-relieving effect. But it's best to pass them by and wait until you have recovered at home with appropriate fluids until you enjoy a celebratory beer.
Try Nothing New on Race Day
Avoid pain relievers before or during the marathon. Use your long training days to experiment with how you feel running or walking without any pain relief, and what effects you have if you resort to using pain relievers. As always, try nothing new on race day.