Pain Management in Italian Elite Athletes: Trends in the Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), Glucocorticoids, and Narcotics in Anti-Doping Reports (2013–2023)

Background: Analgesics are widely used in competitive sports, but their patterns of useand detection in anti-doping controls vary significantly across drug classes. This studyexamined a decade of Italian anti-doping reports with three aims: to describe trends involving non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, and narcotics; tocharacterize the distribution of specific active ingredients; and to analyze the relative contribution of these classes to anti-doping violations, placing the findings within the regulatoryframework. Methods: Data from national anti-doping reporting systems were analyzedfrom 2013 to the first half of 2023. Yearly data included tested athletes, athlete declarationsof NSAIDuse, andlaboratory analytical findings for prohibited substances (glucocorticoidsand narcotics). NSAID prevalence was calculated relative to tested athletes, while glucocorticoid and narcotic findings were assessed as absolute counts and proportions of total violations. Temporal trends were assessed using the Cochran–Armitage test. Results: NSAIDsconsistently ranked as the most frequently reported medication, with nearly half of thetested athletes reporting their use and no significant linear trend in overall prevalence.However, a significant shift was observed within the NSAID class, with a marked de in declarations of COX-2 selective agents over time. Glucocorticoids accounted fora significant portion of prohibited substances, with fluctuating proportions (showing no significant linear trend), betamethasone being the most common active ingredient. Narcoticsappeared only sporadically, although the use of non-prohibited opioids such as tramadoland codeine—absent from official reports—remains relevant for understanding analgesicpractices. Conclusions: Analgesic use in Italian elite sports shows distinct patterns drivenby therapeutic needs and anti-doping regulations. NSAIDs remain the primary choice forroutine pain management, though the type of NSAID reported has shifted significantly.Glucocorticoids represent a notable share of prohibited findings with a fluctuating, ratherthan steadily increasing, pattern. Narcotics appear only sporadically in violation data.Ongoing monitoring will be crucial to understanding how evolving clinical practices andrecent regulatory changes influence future detection trends and athlete health.