Expert Consensus on the Use of NSAIDs and Paracetamol in Sport: A Delphi Study
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are among the most commonly used over-the counter (OTC) medications by athletes for managing pain or discomfort experienced during or after intense physical activity [1], as well as soft tissue injuries [2–8]. Muscle injury is the most frequent type of trauma associated with physical activity, typically caused by strain from eccentric actions [9]. Acutely, it results in fiber damage, reduced force output, followed by inflammatory responses and muscle soreness [10]. Multiple studies show that oral [2–8,11,12] and topical [13,14] NSAIDs (e.g., piroxicam, naproxen, diclofenac) can effectively reduce pain and swelling, and improve function in acute soft-tissue injuries. Furthermore, they may offer faster symptom relief and quicker return to activity. Published literature suggests that oral/topical NSAIDs [9,15–22] (e.g., naproxen, diclofenac, ibuprofen) and paracetamol [23,24] can reduce muscle soreness and enhance recovery after eccentric exercise. While effects on biochemical markers and muscle function vary, most studies report reduced perceived soreness and improved comfort following prophylactic [25,22,26,15,17] or therapeutic [20,27,18] use of paracetamol or NSAIDs during exercise. Physical activity combined with ibuprofen has shown better outcomes than ibuprofen alone. However, topical ibuprofen did not significantly outperform the placebo in reducing soreness [28]. Overall, effects vary depending on timing,…
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