Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis

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updated Aug 1, 2017

Tags: treatment, medications, DOMS, self-treatment, exercise, inflammation, pain problems, muscle

One page on PainSci cites Morelli 2017: A Deep Dive into Delayed-Onset Muscle Soreness

PainSci commentary on Morelli 2017: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

“We can put a man on the moon,” but we still don’t really know if non-steroidal anti-inflammatories (NSAIDs) like ibuprofen have benefits other than pain relief for injured muscle tissue (mostly soreness after exercise). It’s even possible they impair healing by suppressing aspects of inflammation that are necessary for healing. This review of 41 relevant scientific papers, the first of its kind, concluded that NSAIDs may cause a “small to medium” drop in various signs of injury in the short term, compared to recovery without NSAIDs. Curiously, the effect is more pronounced in the lower body.

Also odd: recovery impairment was detected only in animals.

Most of the studies reviewed had a low risk of bias, which is a bit unusual in musculoskeletal medicine, and yet the eight studies that did have a higher risk of bias account for a substantial amount of the benefit detected. Take them out and the positive result starts to look downright unimpressive: a minor effect, on the margin of statistical significance. Arguably those studies should not have been included at all.

So the question still does not seem to be clearly answered. The benefits are unpredictable and/or modest at best.

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: There is debate as to whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is beneficial after acute skeletal muscle injury. Some studies have suggested that NSAID use may be detrimental to injured muscle.

PURPOSE: To determine whether NSAID use affects recovery from skeletal muscle injury as assessed by strength loss, soreness, and/or blood creatine kinase level.

STUDY DESIGN: Systematic review and meta-analysis.

METHODS: An extensive systematic review was completed searching 16 databases (eg, PubMed, Cochrane Library, EMBASE). Inclusion criteria were (1) acute injury to skeletal muscle, (2) use of a control condition, (3) certainty of the NSAID dose administered, and (4) use of 1 or more of the 3 desired outcome measures. A total of 5343 study reports were screened, of which 41 studies were deemed suitable for inclusion. The standardized mean difference was used as the effect size (ES) and was calculated such that a positive ES indicated NSAID efficacy. Meta-analyses were run using a random-effects model.

RESULTS: For all studies, time points after injury, and injury markers combined, NSAID use was found to elicit a small to medium, significant decrease in the markers of injury (overall ES = +0.34; P = .0001). Because heterogeneity in study ES was apparent (ie, Q- df = 52.4, P = .000005; I(2) = 57%), subgroup meta-analyses and meta-regressions were run in an attempt to explain the heterogeneity. In human studies, study ESs were higher when lower body muscles were injured ( P = .045). In animal studies, study ESs were lower with longer NSAID administration durations ( P = .023) and at longer follow-up times after injury ( P = .010).

CONCLUSION: Overall, our analysis supports NSAID use for reducing strength loss, soreness, and blood creatine kinase level after an acute muscle injury, at least for humans and in the short term. Additional research is required to determine why NSAID use appears to be more effective when lower-body muscles in humans are injured. It would also be important to determine why NSAID use appears detrimental at later times after injury in animals but not humans.

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

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