NSAID use as a shared decision-making variable in musculoskeletal rehabilitation and strength and conditioning: a perspective

Pain relief is often considered a key indicator of musculoskeletal rehabilitation and load progression in physical training. However, nonsteroidal anti-inflammatory drugs (NSAIDs) can alter pain perception and symptom expression, posing new interpretive challenges to symptom-based clinical judgment. During NSAID use, decreased pain and improved training completion do not necessarily indicate a synchronous recovery of tissue load tolerance. Adjusting load solely based on immediate symptom changes may lead to an overestimation of rehabilitation progress. This article explores the potential impact of NSAID use on rehabilitation decisions from the perspectives of symptom interpretation and load management. Pharmacological status should be considered a crucial variable influencing clinical reasoning, rather than merely background information in the medical history. Based on the shared decision-making principle, this article proposes the DICE framework (Document, Interpret, Coordinate, Educate), which integrates NSAID-related information into rehabilitation and load-management decisions by standardizing medication information recording, interpreting symptom changes in conjunction with medication context, promoting multidisciplinary team collaboration, and strengthening medication education. This framework is intended to support more consistent symptom interpretation, more informed load progression decisions, and improved communication within rehabilitation teams. This article argues that NSAID use should be incorporated into a dynamic assessment system for rehabilitation and training decisions to more accurately differentiate changes in symptom control, functional recovery, and load tolerance, thereby supporting safer, more transparent, and patient-centered rehabilitation practices.