PAIN+ CPN

Doctor, I have pain due to a recent leg injury from a sports activity. What can you recommend for treatment?

There are many different options. An NSAID cream applied to the skin at the site of the injury seems to work well for some people. NSAIDs taken by mouth and acetaminophen are other options that may be helpful.

What is the evidence?

SUMMARY OF FINDINGS

One treatment versus another treatment or placebo for musculoskeletal injury (not in the lower back) less than 4 weeks old

Treatment*

Pain Relief

within 2 hours

Pain Relief

1-7 days after treatment

Improvement in

Physical Function

Gastrointestinal-related Side Effects
NSAID applied to skinsmall effectsmall effectsmall to moderate effectnone
NSAID by mouthsmall effectsmall effectnonesmall to moderate
Acetaminophensmall effectsmall effectnonenone
Acetaminophen plus diclofenacsmall effectsmall effectnot reportednot reported
NSAID applied to skin plus menthol gelsmall to moderate effectnonenot reportedsmall
Acetaminophen plus opioidnonesmall to moderate effectnot reportedmoderate to large

*Only the results with the moderate or high quality of evidence are reported in this Table

What kind of study was this?

This was a systematic review of 207 studies published up to January 2020.

Who? The studies included 32,959 people with a musculoskeletal injury (not in the lower back) that occurred less than 4 weeks ago (average age 34 years). Common types of injuries included sprains, strains, whiplash. Common sites of injury included neck, chest, upper back, upper limbs, and lower limbs.

What? The studies compared one type of treatment with another type of treatment or with placebo. 

Treatment

vs

Another treatment or Placebo

NSAID cream or NSAIDs taken by mouth

Acetaminophen

Other drugs: ibuprofen, codeine, oxycodone, fentanyl, tramadol

Non-drug treatments: exercise, laser, TENS, joint manipulation, massage, acupressure, ultrasound


Placebo: A pill/needle/lotion containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a "sugar pill."

OR

Another treatment: See description under Treatment

Why was this research done?

Musculoskeletal injuries, such as injuries to the neck, chest, upper back, upper limbs and lower limbs, are common. Which treatment options are the best for reducing pain and improving function while the injury heals? Most studies are too small to provide answers by themselves so the researchers combined 207 studies together in this review (45 treatment options). The treatments that provided at least some relief were NSAID cream applied to the skin, acetaminophen, and NSAIDs taken by mouth. Opioid-containing treatments also offered pain relief, but had more side effects such as nausea and vomiting or constipation. Many other treatments were assessed but the quality of the evidence was not as high.

 **Always check the product label for over-the-counter medications to be sure they are safe for you to take with your other medications and medical conditions.

This Evidence Summary is based on the following article:

Busse JW, Sadeghirad B, Oparin Y, et al. Management of Acute Pain From Non-Low Back Musculoskeletal Injuries: A Systematic Review and Network Meta-analysis of Randomized Trials. Ann Intern Med. 2020 Aug 18. doi: 10.7326/M19-3601. PubMed

Published: Saturday, October 3, 2020