New pointers for aches, pains, and strains – . Well being Weblog
We have all been there before. A minor injury results in a sore ankle, shoulder, or neck. You couldn't do anything, try to ignore it and see if it gets better. Or you might be tempted to take something, especially if significant discomfort is preventing you from doing your usual activities or keeping you up at night.
What is the best initial treatment? If you have minor injuries, you have many options, including:
- Home remedies. Common approaches are the "RICE" treatments – rest, ice, compression and elevation: applying cold to the sore area, wearing an elastic wrap to compress the sore area, resting and lifting (e.g., supporting the sore ankle on pillows).
- Non-drug approaches. For example massage or acupuncture.
- Painkiller. Examples are acetaminophen, anti-inflammatory drugs like ibuprofen, or other pain relievers.
New guidelines have been developed
Recently, the American College of Physicians and the American Academy of Family Physicians brought together experts to develop new recommendations for exactly this type of situation. Officially, these guidelines apply to "acute pain from lower back and musculoskeletal injuries in adults," that is, people whose pain started less than four weeks ago and does not include lower back pain (for which separate guidelines have been developed). .
To elaborate these recommendations, experts reviewed more than 200 randomized controlled trials, which are considered to be the highest quality and most powerful type of evidence. Almost 33,000 subjects (average age 34 years) with various diseases took part in these studies: the most common were sprains (especially on 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.
What the new guidelines recommend
These new guidelines have not specifically commented on the standard home remedies for rest, ice, compression, and elevation, probably because there are no randomized controlled trials of these treatments. However, these measures still seem like a sensible first step.
In addition, the new guidelines recommend the following, in this order:
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs are similar to ibuprofen (as in Motrin), but instead of pills, the drug is applied to the skin over the sore area. There are some over-the-counter (OTC) options (such as diclofenac 1% gel or aspirin-type medicines), but most require a prescription (see below).
- Oral NSAIDs or paracetamol. Many generic and branded oral NSAIDs are available, including ibuprofen and naproxen, and some are sold both OTC and in higher prescription doses. Paracetamol is the active ingredient in Tylenol and many other OTC products.
- Acupressure, or transcutaneous electrical nerve stimulation (TENS). These were found to be somewhat effective, but less so than NSAIDs or paracetamol. The quality of the studies was also poor.
Opiates were not recommended because their benefits are modest and the risks are higher than the other options.
Some caveats about these new guidelines
It is worth noting that
- These newly published guidelines did not consider comparisons between different topical or oral NSAIDs, presumably because such studies do not exist.
- Similarly, they didn't investigate all possible combinations of treatments (e.g., acetaminophen with naproxen), acupuncture (vs. acupressure), or capsaicin, a common topical pain treatment.
- Even the drugs that performed best for benefit and risk were only moderately effective and only marginally better than placebo.
Also note that these guidelines apply to pain caused by minor injuries. For more serious injuries or symptoms, the best first step may be to see a doctor right away, as x-rays or other tests may be important. For example, if you've had a serious ankle injury and can no longer walk or carry weight, it is worth getting checked out. If in doubt, contact your doctor and explain the situation.
More about current NSAIDs
One advantage of current NSAIDs is their security. Compared to pills, fewer drugs are absorbed into the bloodstream, so they tend to cause fewer side effects. This 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 consider topical NSAIDs to be acceptably safe.
However, topical NSAIDs can 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 current NSAIDs.
- Salicylates (the active ingredient in aspirin). Examples are many OTC products such as Aspercreme, Icy-Hot and Bengay.
- OTC diclofenac 1% gel. The brand name is Voltaren Arthritis Pain.
- Prescription drugs. Highly concentrated diclofenac (brand names Flector, Pennsaid, Solaraze). Or compounding pharmacies may provide other NSAIDs in a topical formulation, including ibuprofen, indomethacin, or piroxicam.
The final result
If you've had an injury recently, sorry to hear that! Encourage yourself – most minor injuries will get better within days, regardless of treatment.
However, there are a few things that you can do that may be helpful until the recovery is complete. These new guidelines can help you and your doctor select the most effective and safe options first. Or you can choose no treatment at all. Fortunately, you will likely improve without needing a prescription drug or seeing a doctor.
Follow me on Twitter @RobShmerling
Comments are closed.