We’ve all been there before. A minor injury leads to a sore ankle, achy shoulder, or sore neck. You could do nothing, try to ignore it, and see if it gets better. Or you may be tempted to take something, especially if significant discomfort prevents you from doing your usual activities or keeps you up at night.
So, what’s the best initial treatment? For minor injuries, your options are many, including:
Recently, the American College of Physicians and American Academy of Family Physicians gathered experts to develop new recommendations for just this sort of situation. Officially, these guidelines are for “acute pain from non-low back, musculoskeletal injuries in adults” — that is, for people whose pain started less than four weeks ago and does not include low back pain (for which separate guidelines have been developed).
To come up with these recommendations, experts reviewed more than 200 randomized controlled trials, which are considered the highest quality and most powerful type of evidence. These trials enrolled nearly 33,000 subjects (average age 34) with a variety of conditions: the most common were sprains (especially involving the ankle), strains, and neck injuries. The researchers considered not only pain relief but also physical function, quality of life, patient satisfaction, return to work, and side effects.
These new guidelines did not specifically comment on the standard home remedies of rest, ice, compression, and elevation, probably because randomized controlled trials of these treatments don’t exist. But these measures still seem like reasonable first steps.
Beyond them, the new guidelines recommend the following, in this order:
Opiates were not recommended, as their benefits are modest, and risks are higher than the other options.
It’s worth noting that
In addition, keep in mind these guidelines apply to aches and pains caused by minor injuries. For more significant injuries or symptoms, the best first step may be to see a healthcare provider right away, because x-rays or other evaluation may be important. For example, if you’ve had a significant ankle injury and now cannot walk or bear weight, it’s worth getting checked out. When in doubt, contact your doctor and explain the situation.
One advantage to topical NSAIDs is their safety. Compared with pills, less medication is absorbed into the bloodstream, so they tend to cause fewer side effects. That can be a big deal for people with a sensitive stomach who cannot take oral NSAIDs. People with significant cardiovascular disease may be advised to avoid oral NSAIDs, but their doctors may deem topical NSAIDs acceptably safe.
However, topical NSAIDs may also be less effective than other treatments. For example, hip pain may not improve with topical NSAIDs because the hip joint is far from the surface of the skin.
Here are some examples of topical NSAIDs.
If you’ve had a recent injury, sorry to hear it! Take heart — most minor injuries are better within a few days regardless of the treatment.
But there are things you can do that may be helpful while awaiting recovery. These new guidelines can help you and your doctor choose the most effective and safest options first. Or, you may choose no treatment at all. Fortunately, you’ll probably improve without a needing a prescription medication or seeing a doctor.
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