Background <p>The use of painkillers in football is a much-criticized topic, but there is hardly any scientific data at amateur level. The aim of the study is therefore to establish data on the prevalence of painkiller use in German amateur football. In addition, reasons for painkiller use and other influencing factors are investigated.</p> Methods <p>In a cross-sectional analysis, the painkiller use among German amateur footballers was surveyed through an online protocol, involving players from the 4th league to the lowest amateur divisions.</p> Results <p>Of the 604 participants, 489 were male (81.0%) and 115 were female (19.0%). The prevalence of painkiller use over the players’ entire careers in connection with football is approximately 77%. 75% of players report using painkillers only for acute injuries, with over two-thirds rarely or never taking them before a game. At 80%, female players report slightly higher painkiller use for acute injuries than male players (74.4%, <i>p</i> = 0.19). Age-related differences show that older players take painkillers more frequently than younger players (<i>p</i> &lt; 0.001). Furthermore, league-specific differences show that higher playing levels (4th league) are associated with higher pain prevalence and higher painkiller use compared to the lowest five leagues (<i>p</i> &lt; 0.001).</p> Conclusions <p>This is the first study to record the use of painkillers in amateur football from the players’ perspective with a large sample size. The lifetime prevalence of painkiller use among amateur football players in this study matches levels found in previous studies of amateur and professional sports. Most players take painkillers for medically justified reasons, with misuse being minimal. However, a minority of players show less responsible usage. Further research into the contextual factors influencing painkiller use is needed, and educational initiatives are important to improve awareness regarding pain management in football.</p>