Does Tylenol (acetaminophen) help with Delayed Onset Muscle Soreness (DOMS)?

Tylenol (Acetaminophen) for Delayed Onset Muscle Soreness (DOMS)

Tylenol (acetaminophen) alone is not recommended as a primary treatment for DOMS as it does not show statistically significant improvement in function or symptom relief compared to placebo, despite providing some pain reduction. 1

Effectiveness of Acetaminophen for DOMS

• Acetaminophen alone provides moderate pain reduction at both early timepoints (less than 2 hours) and later timepoints (1-7 days) compared to placebo, with a weighted mean difference of -1.03 cm and -1.07 cm respectively on a 10-cm visual analog scale 1
• Despite this pain reduction, acetaminophen does not show statistically significant improvement in physical function compared to placebo (low-certainty evidence) 1
• Acetaminophen alone does not show statistically significant improvement in symptom relief or treatment satisfaction compared to placebo (moderate-certainty evidence) 1

Better Alternatives for DOMS

• Topical NSAIDs are among the most effective interventions for DOMS with high-certainty evidence showing superior treatment satisfaction compared to placebo (OR, 5.20) 1, 2
• Topical NSAIDs significantly improve physical function (WMD, 1.66 cm) and provide symptom relief (OR, 6.39) compared to placebo 1, 2
• Oral NSAIDs also provide better outcomes than acetaminophen, with significant improvements in physical function (WMD, 0.73 cm) and symptom relief (OR, 3.10) 1, 2

Non-Pharmacological Alternatives

• Several non-pharmacological interventions show better effectiveness for DOMS than acetaminophen:
  • Specific acupressure improves physical function (WMD, 1.51 cm) and decreases pain (WMD, -2.09 cm) compared to placebo 1
  • Laser therapy significantly improves symptom relief (OR, 32.08) 1, 2
  • TENS reduces pain at 1-7 days (WMD, -1.18 cm) 1, 2
• Physical interventions including contrast techniques, cryotherapy, phototherapy, vibration, ultrasound, massage, active exercise, and compression have shown beneficial effects in managing DOMS-related pain 3

Combination Therapies

• If medication is needed, acetaminophen combined with other agents may be more effective:
  • Acetaminophen plus oral diclofenac improves symptom relief (OR, 3.72) compared to placebo 1
  • Acetaminophen plus chlorzoxazone reduces pain at 1-7 days (WMD, -2.92 cm) 1
• However, combinations of acetaminophen plus ibuprofen did not show statistically significant improvement in symptom relief compared to placebo 1

Safety Considerations

• Acetaminophen has a better gastrointestinal safety profile than NSAIDs 2
• Oral NSAIDs increase the risk of gastrointestinal adverse events (OR, 1.77) compared to placebo 1
• When considering treatment options for DOMS, the risk-benefit profile favors topical NSAIDs over oral medications due to fewer systemic side effects 2

Clinical Approach to DOMS

• For acute DOMS management, start with topical NSAIDs as first-line treatment due to superior efficacy and safety profile 1, 2
• If topical NSAIDs are not available or practical, oral NSAIDs provide better symptom relief than acetaminophen 1
• Reserve acetaminophen for patients who cannot tolerate NSAIDs due to contraindications such as gastrointestinal issues, renal impairment, or allergies 2
• Consider non-pharmacological approaches like specific acupressure, TENS, or massage as adjuncts or alternatives to medication 1, 2, 3