Over-the-counter pain relievers may shorten concussion recovery time

Key takeaways:

• Athletes who used over-the-counter analgesics after a concussion returned to unrestricted sports play faster than those who did not.
• Earlier administration was linked to better outcomes.

SAN DIEGO — Over-the-counter pain relievers improved concussion symptoms and time to recovery, with earlier use providing the greatest benefit, according to a speaker.

“Concussions are a pretty common problem, about 1.6 to 3.8 million per year. Over-the-counter analgesics are frequently used post injury and are a staple of treatment,” Kyle Arnold, MD, neurologist at the University of Washington, said during his presentation at the American Academy of Neurology Annual Meeting.

Arnold and colleagues conducted a prospective cohort study to determine the effects of post-concussion over-the-counter (OTC) analgesic use in National Collegiate Athletic Association (NCAA) athletes and military cadets in the U.S. Department of Defense CARE Consortium.

“At this point, there’s a few limited large-scale clinical studies that look at this question of analgesics for concussion,” Arnold said.

The analysis included more than 1,600 individuals divided into four subcategories based on post-concussion treatment strategy: those who used acetaminophen (n = 660), those who used NSAIDs (n = 75), those who used both (n = 78) and those who did not use OTCs (n = 848).

The main study outcomes were concussion recovery as measured by the number of days from the injury until return to unrestricted play, along with time from injury until clearance to a return-to-play protocol.

The researchers assessed concussion symptoms and headache severity with the Sports Concussion Assessment Tool (SCAT-3) immediately post injury (up to 1 day after) and 3 or more days post injury.

At baseline, 53.5% of participants who did not use OTCs and 34.1% of those who did sustained a concussion during a full contact activity, while 5.3% and 4.7%, respectively, sustained an injury during non-contact activity.

At 50% probability, participants who used OTCs returned to unrestricted play 1.9 days sooner and were cleared for the return to play protocol 1.1 days sooner, compared with non-OTC users. At 90% probability, those numbers increased to 7 days and 3 days sooner, respectively.

Arnold and colleagues also reported that, overall, earlier use of OTCs was associated with faster unrestricted return to play (HR = 0.84) and clearance to the return to play protocol (HR = 0.82) vs. non-OTC use.

Data further showed that OTCs were associated with lower concussion symptom severity and headache severity vs. non-OTC use. There were no significant differences between OTC analgesic type and concussion recovery or symptom severity, Arnold said.

“We didn’t see any significant difference between NSAIDs and acetaminophen, which is surprising based on our initial hypothesis,” he said. “We saw that earlier use supplies the greatest benefit.”

Future research should include “trials to better assess causality and to figure out what the exact right timing is that is associated with recovery,” Arnold concluded.