Author(s): BARIGUIAN, F., MOBASHERI, A., MORLION, B., SMITH, G., SNATCHFOLD, J., SEEFRIED, L., KUSHNER, P., EVERT, V., BAHTIJAREVIC, Z., Institution: HALEON, Country: SWITZERLAND, Abstract-ID: 2033

INTRODUCTION:
Athletes frequently present to healthcare clinicians with sports-related pain, including acute soft‑tissue injury and delayed‑onset muscle soreness (DOMS). Despite the widespread use of non‑steroidal anti‑inflammatory drugs (NSAIDs) and paracetamol, the high prevalence and risks associated with their inappropriate use highlight the need for sport‑specific, evidence‑informed guidance. [1,2] To address this gap, a modified Delphi approach was applied to integrate expert opinion with current evidence to establish consensus recommendations for NSAIDs and paracetamol use in acute soft-tissue injury and DOMS among athletes and healthcare clinicians.
METHODS:
A two-step modified Delphi method was employed to establish consensus among a multidisciplinary international panel. The panel consisted of six experts from Germany, Belgium, the United States, Finland, and Switzerland, each with >5 years of relevant clinical/research experience (sports medicine, orthopaedics, physiotherapy, pharmacology/pharmacy, pain/anesthesiology), convening virtually and in person. Pre‑meeting literature summaries from PubMed and Embase (inception–September 2025) with informed consensus development across three predefined domains: acute soft-tissue injury, DOMS, and performance. Anonymous voting conducted via Qualtrics using a 5-point Likert scale (“Strongly agree” to “Strongly disagree”), with consensus defined as ≥67% agreement. Two rounds were planned a priori, concluding after round 2 when no further substantive modifications were proposed, and item ratings finalised.
RESULTS:
Twenty statements were evaluated across two Delphi rounds. Four were revised after round one. Consensus was achieved on 19 statements, as 2 were combined into 1. For acute soft‑tissue injury, the panel agreed that short‑term oral or topical NSAIDs or oral paracetamol are appropriate when no contraindications exist, with oral therapy of NSAIDs limited to 3–7 days. Topical NSAIDs may be initiated within 24 hours to enhance analgesia, not exceeding 2–3 applications daily according to label‑directed frequency and duration. For DOMS, recommendations were similar, with oral NSAIDs use restricted to 3–5 days and topical NSAIDs applied within 24 hours under the same label‑based limits. Concurrent oral NSAIDs with paracetamol may be considered when monotherapy is insufficient. Safety considerations included contraindications to oral NSAIDs in gastrointestinal ulcer, renal impairment, hypersensitivity and caution in older adults, adolescents, individuals with cardiovascular risk, those on anticoagulants, and during pregnancy/lactation. The panel did not endorse the use of oral NSAIDs or paracetamol by athletes as a means to enhance performance.
CONCLUSION:
These consensus statements provide standardised, evidence-based guidance on NSAIDs and paracetamol use for acute soft-tissue injury and DOMS, and may assist healthcare professionals in clinical decision-making.
[1] Prior 2012 [2] Xiong 2025