New guideline for managing acute pain from musculoskeletal injuries

In a 2017 practice guideline based on a systematic review of noninvasive medicines, the American College of Physicians( ACP) recommended superficial heat, massage, acupuncture, and spinal manipulation as initial treatment options for cases with acute low-grade back ache, in addition to providing a nonsteroidal anti-inflammatory drug( NSAID) or skeletal muscle relaxant if wanted. But is a similar coming effective for treating anguish from acute musculoskeletal injuries not involving the lower back? To answer this question, the American Academy of Family Physician( AAFP) connected the ACP in developing another practice guideline on management of acute pain from non-low back, musculoskeletal harms in adults, a synopsis of which appeared in Practice Guidelines in the December 1 issue of American Family Physician. These are some key rehearse times from administrative guidelines 😛 TAGEND

* Topical NSAIDs are the most effective intervention for acute musculoskeletal agony other than low-pitched back grief .* Although oral NSAIDs and acetaminophen are effective for acute sting succour, compounding them does not improve effectiveness .* Although moderately effective for agony relief, opioids increase gastrointestinal and neurologic adverse effects and lead to long-term use in 6% of parties plowed .* Acupressure and transcutaneous electrical nerve stimulation techniques are effective nonpharmacologic options for acute pain.

In an accompanying editorial, Dr. David O’Gurek and I, who represented the AAFP on the guideline committee, and Dr. Melanie Bird, AAFP Clinical and Health Policy Manager, discussed some of the guideline’s foregrounds and limitations. A systematic review and structure meta-analysis of randomized, ensure contests furnished direct and indirect comparings of various treatment options on aftermaths that included pain easing and physical functioning, indication succor, medication gratification, and adverse events.

Topical NSAIDs improved all efficacy outcomes with minimum adverse effects, while oral NSAIDs and acetaminophen improved fewer outcomes and were more likely to cause adverse events. We indicated against consuming opioids, including tramadol, for acute musculoskeletal injury agony due to their poor adverse effect profile and the hazards of prolonged utilization, ranging from 6% in low-risk to 27% in high-risk people. We also noted that “equitable coverage and affordability of first-line treatments” are essential to reduce well-known ethnic and socioeconomic disparities in pain management; for example, though a topical NSAID is now available over-the-counter, it expenses significantly more than oral NSAIDs and acetaminophen and may not be covered by health insurance plans.


This post first is available on the AFP Community Blog.

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