Objectives: To identify the prevalence, frequency, adverse effects, and reasons for analgesic use in youth athletes. Design: Systematic review and meta-analysis. Methods: Systematic searches in Embase, Medline, and SPORT-Discus from inception to September 2021, screening of reference lists, and citation tracking were performed to identify observational studies including athletes aged 15-24 years and reporting data on prevalence and/or frequency of analgesic use. Study quality was assessed using the Newcastle-Ottawa Scale. Random-effect proportion meta-analyses, stratified by type of analgesic medication and prevalence measure, estimated the prevalence of analgesic use. Data on usage frequency, adverse events, and reasons for analgesic use was synthesized narratively. Results: Forty-nine studies were included (44,381 athletes), of which 19 were good/high quality. Seven categories of analgesics were identified across 10 prevalence time-points. Meta-analyses suggested common use of NSAIDs (point prevalence 48% [95% CI 23% to 73%], in-season prevalence 92% [95% CI 88% to 95%]). The lowest prevalence was found for use of local anesthetic injections within the previous 12 months (2% [95% CI 1% to 3%]). Seven to 50% of athletes reported weekly analgesics use. The proportion of adverse events ranged from 3.3% to 19.2%. Reasons for using analgesics included treatment of sports-related pain or injury, to treat illness, and to enhance performance. Conclusions: Analgesics are commonly used in youth athletes, but estimates vary depending on type of analgesic and prevalence measure. As the majority of studies were of poor methodological quality, future high-quality research should include prospective data collection of analgesic use to understand consumption trajectories.
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