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 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 results with 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

Treatment

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."

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 reviewers 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
Last Updated: Saturday, February 19, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2024/12/21.

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