The clinical significance of coanalgesics in pain modulation among athletes

Introduction

Pain is one of the most common complaints associated with physical activity, both in professional and recreational sports. As a physiological and subjective phenomenon, pain serves a protective function, warning of potential injury or overuse. However, if left untreated, it may lead to chronic pain conditions, impaired motor function, or even permanent exclusion of the athlete from activity. Therefore, effective and safe pain management is essential to maintain training continuity, prevent complications, and support athletes’ optimal psychophysical performance. Standard therapeutic approaches in athletes typically involve the use of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and—in the case of more severe pain—opioid medications. However, increasing attention has been paid to coanalgesics, a group of drugs that are not classified as traditional analgesics but exhibit supportive or potentiating effects on pain relief. Coanalgesics—including antidepressants, anticonvulsants, glucocorticoids, local anesthetics, and even certain dietary supplements—are especially useful in treating neuropathic, chronic, or multifactorial pain. In the context of sports, these agents may play a crucial role in reducing the required doses of standard analgesics, minimizing side effects, and facilitating return to full physical functionality. Given the unique characteristics of the sports environment—including time pressure, high physical demands, anti-doping regulations (e.g., WADA), and ethical considerations—appropriate analgesic selection must not only be effective but also safe, rational, and compliant with governing rules. When used appropriately, coanalgesics may serve as alternatives or adjuncts to classical pain management strategies.