SUMMARY OF FINDINGS
One treatment versus another treatment or placebo for musculoskeletal injury (not in the lower back) less than 4 weeks old
within 2 hours
1-7 days after treatment
|Gastrointestinal-related Side Effects|
|NSAID applied to skin||small effect||small effect||small to moderate effect||none|
|NSAID by mouth||small effect||small effect||none||small to moderate|
|Acetaminophen||small effect||small effect||none||none|
|Acetaminophen plus diclofenac||small effect||small effect||not reported||not reported|
|NSAID applied to skin plus menthol gel||small to moderate effect||none||not reported||small|
|Acetaminophen plus opioid||none||small to moderate effect||not reported||moderate to large|
*Only the results with the moderate or high quality of evidence are reported in this Table
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.
Another treatment or Placebo
NSAID cream or NSAIDs taken by mouth
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."
Another treatment: See description under Treatment
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