Does aspirin, codeine and paracetamol reduce muscle soreness?

The effect of painkillers on muscle soreness

Do common painkillers have any role to play in the management of delayed-onset muscle soreness (DOMS) – the pain, tenderness and restriction of movement which commonly peaks 2-3 days after strenuous or unaccustomed exercise?

 That’s the question researchers from Coventry and Northern Ireland set out to answer with a study comparing the efficacy of aspirin, codeine and paracetamol in managing DOMS over a period of 11 days.

Sixty healthy volunteers (30 men, 30 women) were randomly allocated to one of five experimental groups: aspirin (900mg per day); codeine (60mg); paracetamol(1000mg); placebo (lactose tablets) and control (no treatment). Each subject attended for a total of seven sessions over 11 days: Monday to Friday of the first week and Monday and Thursday of the following week. DOMS was induced at the first session in the nondominant elbow flexors using a standardised exercise protocol of repeated eccentriccontractions.

A number of pain and movement variables were measured before administration of the various medications and again 90 minutes afterwards. All the participants except those in the control group also took their medication on non-attendance days.

The findings were exceptionally clear-cut and consistent:

* All five groups experienced predictable loss in range of movement following DOMS induction, with no significant differences between them;
* All groups experienced a similar decrease in mechanical pain threshold (ie an increase in tenderness) after induction, which peaked on day three and gradually returned to pre-exercise levels by day 11;
* All groups reported an increase in pain after initial exercise, probably due to fatigue, which subsequently decreased after the first treatment. From day 2 onwards pain levels began to increase, peaking for all groups between days 3 and 4, then decreasing until day 11 when very little residual pain was present. Again there were no significant differences between groups;
* Pain ratings derived from questionnaires completed on days 1 and 3 again showed no significant differences between the groups although, interestingly, most groups indicated that the actual induction procedure produced more pain than the delayed soreness.

The analgesics used in this trial were selected because of their availability and previously reported benefits when used to treat other laboratory-induced models of pain. Aspirin has been promoted as an effective drug in alleviating pain from ‘almost any cause’, and at least one previous study had suggested it was useful in decreasing DOMS soreness. However, the result may have been biased by the absence of a placebo group. The current study, which eliminated bias by using a placebo group, suggested that aspirin was actually the least effective form of analgesia for DOMS.

Codeine has been shown to alleviate various types of pain effectively, including ischaemic, electrical, thermal and postoperative pain, but had not until now been studied for the relief of DOMS. Paracetamol had not been used to alleviate DOMS either, although it has been shown to be effective against laser-induced pain, mechanical pain and post-operative dental pain. In this study it did not provide significant pain relief at any point, although the researchers point out that it provided ‘better qualitative effects than either codeine or aspirin’.

They conclude: ‘Our study provides no evidence of the effectiveness of the analgesics used in decreasing the pain associated with DOMS, at least at the dosages and parameters discussed here… Furthermore none of the medications showed any significant beneficial effect on any of the other symptoms of DOMS. It remains to be seen if increasing the dosage of the analgesics used in this study would have any significant beneficial effect on any of the symptoms associated with this condition.’

Isabel Walker

Arch Phys Med Rehabil Vol 81, July 2000

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