Thursday, June 21, 2012

NSAIDs May Hinder Not Help Sore Muscles

NSAIDsMany persons experience muscle pain after heavy exercise, which may persist for some time. Taking nonsteroidal anti-inflammatory drugs (NSAIDs) to ease the discomfort is common practice; however, new research suggests that this may not be beneficial. In fact, the pain may be prolonged with NSAIDs.

At the latest annual meeting of the European League Against Rheumatism (EULAR 2012), Matthias Rother, MD, PhD — of International Medical Research in Graefelfing, Germany — and colleagues presented research examining the effects of two NSAIDs with different anti-inflammatory potency on muscle soreness due to strenuous exercise. They conducted two randomized, placebo-controlled studies of similar design in which muscle soreness was induced by having healthy subjects walk down stairs, the exact number of which was determined by body weight, but similar to walking down from the top of a 100-story building.

Here is a summary of the 2 studies and their outcomes:

  • STUDY 1 — subjects were randomly assigned to either twice daily celecoxib 200 mg (N=40) or placebo (N=40) for 7 days following exercise. Maximum pain during contraction of the calf was experienced from 24 to 48 hours after exercise (pain scores on an 11 point scale were about 4 to 5), and there was a non-significant trend of pain reduction in the celecoxib group over time (scores ranging from roughly 3.7 to 4.4). For thigh contraction, scores at each time point were virtually identical between the NSAID versus placebo.

  • STUDY 2 — subjects in this study were randomly assigned to either twice daily ketoprofen 100 mg (N=24) or placebo (N=48) for 7 days following exercise. Ketoprofen administration resulted in pain reduction in calf and thigh muscles as compared with placebo during the first 24 hours of treatment; however, considering the full 7-day observation period, the ketoprofen group actually showed higher pain scores as compared with placebo (P=0.024). Also, maximum pain and time to maximum pain relief were numerically higher for the ketoprofen group. Evaluation of all parameters indicated that most of the negative effect of oral ketoprofen was caused by a significant delay of time to full recovery (P<0.005) — discomfort ended at about 5 days (122 hrs.) in the ketoprofen group versus roughly 4 days (105 hrs.) in the placebo group.

The authors conclude that, the more potent anti-inflammatory drug ketoprofen appears to cause unfavorable effects on recovery from muscle soreness induced by strenuous exercise, as compared with less potent celecoxib. Neither NSAID was superior to placebo and the results of their studies could imply that the inflammatory reaction following muscle injury induced by exercise is an essential part of recovery. Therefore, since even the benefits of celecoxib were only modest and not significant, the use of NSAIDs for the treatment of exercise induced muscle soreness cannot be recommended.

CLINICAL CONCEPTS: These studies were published as abstracts at a clinical conference, so their data and conclusions should be considered as preliminary until publication in a peer-reviewed journal. The trial designs were straightforward; however, the studies were only modestly powered statistically and generalization of the outcomes, which focused on only two NSAIDs, to the whole class of NSAID analgesics is questionable at this time.

The researchers do note that their findings were consistent with a study that found ultra-marathon runners who took NSAIDs following the race did not experience reduced muscle damage or soreness relative to those who went untreated (Nieman, et al. Brain Behav Immun. 2005;9:398-403). Another study indicated that ketoprofen extended the time with pain following tonsillectomy as compared with celecoxib (Nikanne, et al. Otolaryngol Head Neck Surg. 2005;132:287-294).

The implication is that inflammation in certain acute pain situations has a beneficial role in resolving the discomfort, and that attempts to suppress this process may lengthen the time to recovery. For example, muscle pain after heavy exercise is natural and may be healthy, and taking anti-inflammatory drugs for normal soreness could be deleterious. Conjecture regarding other pain conditions, including more chronic musculoskeletal pain, was not discussed in the present research.

Unfortunately, from the limited information available at this time it is unknown what the researchers might recommend as a better approach for dealing with acute musculoskeletal discomfort. In the present studies, the maximum pain was moderate — reaching about 5 on a 0-to-10 scale — and there was no evidence of traumatic injury; so, advising patients to merely endure the soreness for several days might be acceptable. In other cases, this may not be the most prudent or preferred approach.

REFERENCE: Rother M, Seidel EJ, Fischer A, et al. Is the inflammatory reaction an essential part of recovery after muscle injury? Presented at EULAR 2012, abstract FRI0457; also in Ann Rheum Dis, 2012;71(Suppl3):469 [abstract here]. Also reviewed in MedPage Today, June 11, 2012 [here].

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