Running Through Pain?
The Hidden Dangers of Painkillers for Endurance Runners
Why We’re Talking About Painkillers
It’s common to hear runners speak of sore muscles, aching joints or injuries. The temptation? To reach for over-the-counter (OTC) painkillers just to get through the next training session or line up for race day.
But painkillers don’t fix the problem. In fact, when used regularly or without appropriate supervision, they can mask symptoms, impair healing and potentially put your health at risk.
Using paracetamol, ibuprofen, or aspirin as a quick fix or regularly without a clear plan can do more harm than good, especially when race day rolls around.
And yes, this matters even if you’re a recreational runner, not an elite.
Common Painkillers Used by Runners
The most frequently used OTC pain medications include:
Paracetamol (Acetaminophen) – commonly taken for mild to moderate pain or fever.
NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) – such as ibuprofen and aspirin, used to relieve pain, inflammation, and fever.
Are you a habitual user? Ask yourself:
Are you taking painkillers before every long run or race?
Are you combining them with period pain relief?
Do you reach for them as a regular part of your recovery?
It’s the chronic load that appears to cause most of the long-term damage. However there are serious one-off race day health risks, which we’ll cover later in this article.
If you’re managing persistent pain or injury, instead of resorting to OTC medication, consider exploring nutrition and lifestyle changes as part of your personalised support plan alongside professional health support.
Timing Matters Too
If pain relief is genuinely needed, some general guidance includes:
NSAIDs: Avoid pre-run or mid-run doses. If used, take after a run, ideally 2+ hours later and once fully rehydrated and not for more than 4 consecutive days.
Paracetamol: Can be used occasionally for a headache or minor pain but exceeding daily dose limits carries a risk of liver toxicity.
Always read the patient information leaflet and follow your health practitioner’s advice.
What Actually Works: Nutrition & Recovery
Let Food Be Your First Line of Defence
There’s no shortcut to strong, pain-free running but there is a smarter way.
The EAT TO RUN approach is about fuelling performance and recovery with targeted, real food strategies NOT relying on medication to get you through.
There are occasions when OTC medication is required but save this for the acute health situations.
For everyday health and run training, be proactive by supporting your immune system and inflammatory load by minimising the overall stress placed on your body through diet, lifestyle and training load.
The goal isn’t to suppress inflammation entirely, it’s to keep it in balance so your body can recover and repair efficiently.
Food First: Anti-Inflammatory Nutrition for Runners
Instead of pills, here are food-based strategies that work with your body:
Pain is your body’s alert system, not something to suppress. Instead of masking pain, focus on supporting it naturally:
🐟 Omega-3s
Oily fish or supplements offer anti-inflammatory effects (EPA/DHA), supporting joint health and immune function.
🌿 Turmeric (Curcumin)
This spice helps reduce soreness post-exercise, 100–500 mg/day consistently is effective.
🍒 Other Anti-Inflammatory Foods
Tart cherry juice, green tea, beetroot, watermelon, bromelain (pineapple), capsaicin (chilli), and resveratrol all support inflammation regulation when eaten regularly.
The Race-Day Risk You Didn’t See Coming
Many runners pop these medications as a ‘preventative’ before a race, I imagine many don’t know the potential health risks of doing this. A recent Runner’s World (UK) feature, “The Perils of Painkillers” by Sophie Raworth, highlights just how dangerous NSAIDs can be when taken before or during a race.
Here’s what can happen:
Kidney Stress and Dehydration: NSAIDs inhibit prostaglandins that help maintain kidney blood flow. In the dehydrated state common in marathons, this can impair kidney function - sometimes severely.
Gut Integrity Breakdown: Coupled with reduced gut blood flow during intense exercise, NSAIDs can damage the stomach lining and even cause bacteria to enter the bloodstream raising the risk of infection and 1endotoxaemia.
Sodium Imbalance (EAH): NSAIDs contribute to 2exercise-associated hyponatraemia, a serious drop in blood sodium, especially if you're drinking large volumes of water.
These risks have led elite races like the London Marathon to advise against NSAID use within 48 hours of the event. With little evidence of performance benefits and mounting health risks this guidance is stronger than ever.
Race-Day Safety
If painkiller use seems necessary around a race, follow these rules:
Avoid pre or mid-race NSAIDs, save them for after the run and only once fully hydrated.
If you develop pain during a race stop at a medical help station and they will advise on pain medication during the race.
Follow race-specific medical guidance. Many race organisers issue health advisories similar to London Marathon’s 48-hour NSAID warning.
Final Takeaways
Relying on OTC painkillers, especially NSAIDs, can lead to kidney stress, gut damage, hyponatraemia, and delayed recovery.
On race day, the stakes are even higher - risks of kidney issues, and sodium imbalance skyrocket.
Focus on anti-inflammatory nutrition, good hydration, rest, and injury prevention.
If you must use painkillers, use them rarely, strategically, and always under professional advice.
Final Thought:
Relying on paracetamol or ibuprofen might be doing more harm than good. Use natural alternatives to support recovery, resilience and long-term running health.
Let your training and nutrition support rather than suppress your body.
Have you raced with or avoided painkillers? Have you explored natural alternatives?What strategies have helped your recovery? Please share your experiences in the comments, let’s learn from each other.
Endotoxemia refers to the presence of endotoxins in the bloodstream. This can trigger a systemic inflammatory response.
Exercise-associated hyponatremia (EAH) is a condition where sodium levels in the blood drop to below 135 mmol/L during or after prolonged exercise. It's caused by overhydration, especially with hypotonic fluids (like water or sports drinks without electrolytes). EAH can occur in various endurance activities, including running, hiking, and triathlon. EAH can lead to Mild symptoms: Weakness, fatigue, headache, nausea, and dizziness and Severe symptoms: Altered mental status, seizures, coma, and even death in extreme cases.