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NSAIDs Comparable to Other Oral Analgesics for Acute Musculoskeletal Injury
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The authors evaluated the published evidence to compare the effectiveness of oral non-steroidal anti-inflammatory drugs (NSAIDs) with that of other oral analgesics such as opioids and acetaminophen for pain in acute musculoskeletal injury.
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The authors observe that NSAIDs are at least as effective as other analgesics to control pain and may, in fact, be more beneficial in terms of fewer adverse effects compared with narcotics.
abstract
This abstract is available on the publisher's site.
Access this abstract nowNonsteroidal anti-inflammatory drugs (NSAIDs) are at least as effective as other oral analgesics (opioids, acetaminophen) in relieving pain in the first few days after an acute musculoskeletal injury. Evidence also indicates that using NSAIDs results in fewer adverse events than using narcotics (strength of recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs], as well as individual RCTs).
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Disclosure statements are available on the authors' profiles:
How Do Oral NSAIDs Compare to Other Oral Analgesics Right After an Acute Musculoskeletal Injury?
J Fam Pract 2018 Feb 01;67(2)110-111, C Lyon, S Piggott, S Langner, K DeSantoFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
NSAIDs vs Opioids for Soft Tissue Injury Pain
This study reviewed three articles and found NSAIDs to be as effective for soft tissue pain as opioids.1 This is an exciting finding in an age of an opioid epidemic. A Cochrane review of 16 trials showed no difference in soft tissue pain between NSAIDs and opioids.2 The 2144 participants were from two pediatric trials and included mostly young patients in the other 14 trials. The second study also showed no difference in efficacy, with more side effects in the opioid group.3 The average age was 36 years. A third study showed equal efficacy from NSAIDs and acetaminophen in soft tissue injury of young adults, also 36 years old.4
NSAIDs as well as Cox-2 inhibitors are on the Beers list and should not be used in older adults. Prostaglandins are vasodilators and NSAIDs are prostaglandin inhibitors, causing vasoconstriction. In young patients this is not a problem; but, in older adults with varying levels of atherosclerosis, it can be detrimental. NSAIDs increase the risk of renal failure and heart failure (RR, 1.8 [95% CI, 1.4–0.4]; atrial fibrillation HR, 1.8 [95% CI, 1.07–2.88], and cardiovascular deaths HR, 1.4 [95% CI, 1.3–1.5]).5-8 We should start with heat and cold, physical therapy, stretches, massage, acupuncture, and other nonpharmacologic options, and use acetaminophen if needed for soft tissue injuries in older adults.
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