Background/Purpose: Eccentric muscle contraction causes an inflammatory reaction with pain peaking 24 to 48 hours after exercise – delayed onset of muscle soreness (DOMS). NSAIDs are used frequently for treatment or even prevention of DOMS. But evidence for treatment effects of NSAIDs is controversial. Timing of intervention and pharmacological properties of the specific NSAID tested might explain the controversial results. In two previous studies using a daily life oriented model of DOMS induced by walking down stairs we found for 200 mg celecoxib when given about 16 h after exercise a modest, insignificant reduction in pain [Phys Med Rehab Kuror 2012; 22: 57–63]. Ketoprofen (100 mg bid), a higher potent anti-inflammatory drug, caused a delay in recovery from DOMS when given immediately after exercise [Phys Med Rehab Kuror 2012; accepted for publication].This study investigated the effects of a Cox-2 inhibitor (90 mg qd etoricoxib) on markers of inflammation, pain and muscle force after eccentric exercise.

Methods: Randomized, double-blind, placebo-controlled, cross over study in 50 healthy subjects exposed to equipment based, eccentric exercise of the lower limb (“extrafit Beinstrecker”, extrafit INVESTMENT GmbH, Germany). Subjects with pain during muscle contraction of at least 5 on an 0-10 point categorical scale at 16±2 h after exercise were eligible for randomization. Pain at rest and during contraction, muscle force, pain threshold at tender point and markers of inflammation (high sensitive C-reactive Protein (hsCrP), sedimentation rate, leucocyte number) were evaluated at various time points during the treatment period of 7 days.

Results: There is a non significant trend for reduction of pain at rest with etoricoxib treatment for the first 24 h of treatment (etoricoxib: 10.4±9.7, placebo: 11.5±9.9). For peak torque and pain threshold at the tender point, there is a trend of delayed recovery with etoricoxib treatment. HsCrP is increased due to DOMS and showed significant cross-over effects (p=0.0089). The carry-over effect might be due to anti-inflammatory effects of etoricoxib in period I (p=0.0341) carried over into period II. This is in line with the overall result indicating a significant long term anti-inflammatory effect evident through a reduction in hsCrP as compared to placebo (p=0.0203). Overall, also a trend of reduction in model induced increase of leucocytes (p=0.0981) was shown. Sedimentation rate was insensitive to the model and treatment effects.

Conclusion: Equipment based eccentric exercise of the lower limbs appears to be a robust model of muscle pain. This approach allows the design of cross-over studies since the exercise load can be individualized and adapted to differences in muscle force of the dominant vs. non-dominant limb. Treatment related effects are in line with previous studies indicating a modest analgesic effect but evidence for delayed recovery. This supports the concept that the inflammatory reaction is an essential part of the recovery process. Anti-inflammatory treatment might cause a delay in recovery. Caution should be used when using NSAIDs for the treatment of exercise induced muscle pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/nsaids-suppress-the-inflammatory-reaction-related-to-muscle-soreness-but-may-delay-recovery/