Guideline: Clinicians Should Use NSAIDs for Acute Musculoskeletal Pain

By Jonathan Springston, Editor, Relias Media

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) authored new recommendations that call for alternatives to opioids to treat non-low back pain that stems from musculoskeletal injuries.

Clinicians should use topical non-steroidal anti-inflammatory drugs (NSAIDs), with or without menthol gel, to treat this pain, as well as oral NSAIDs, specific acupressure, and transcutaneous nerve stimulation. All these should be considered before opioids, according to the guideline authors, who suggest using opioids only in cases of extreme pain or if the recommended first-line NSAID therapy fails.

“This guideline is not intended to provide a one-size-fits-all approach to managing non-low back pain,” AAFP President Gary LeRoy, MD, said in a statement. “Our main objective was to provide a sound and transparent framework to guide family physicians in shared decision-making with patients.”

Musculoskeletal injuries are common, leading to millions of healthcare visits and billions in treatment costs every year in the United States. ACP and AAFP committees analyzed more than 200 studies of about 33,000 patients, comparing the efficacy of pharmacologic and nonpharmacologic interventions on acute musculoskeletal pain.

“As a physician, these types of injuries and associated pain are common, and we need to address them with the best treatments available for the patient. The evidence shows that there are quality treatments available for pain caused by acute musculoskeletal injuries that do not include the use of opioids,” ACP President Jacqueline W. Fincher, MD, said in a statement. “There are a number of recommended interventions that are not opioids to choose from, and topical NSAIDs should be the first line of treatment.”

For further discussion on the opioid crisis, be sure to check out Episode 2 and Episode 12 of the “Rounds With Relias” podcast series.