Musculoskeletal Pain Treatment Reviewed
Last month two physician groups, The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP), released updated guidelines for addressing acute musculoskeletal pain. The two groups represent family physicians and primary care doctors. The recommendations were based on a comprehensive review of available evidence. After the comprehensive review, their recommendation was to avoid opioid use in the treatment of acute musculoskeletal pain.
The recommendations they issued in the most recent study related to the treatment of acute musculoskeletal pain other than that stemming from low back musculoskeletal injuries – the ACP had previously released guidelines, also endorsed by the AAFP, for the treatment of chronic and acute low back pain.
How the Guidelines Were Reached
The new recommendations were issued following an extensive review of over 200 clinical trials and their results. The trials encompassed a large variety of injuries and included more than 32,000 patients. Some of the injuries studied within the trials include:
- Fractures
- Muscle sprains and strains
- Ankle injuries
- Whiplash
- Hamstring injuries
- Neck injuries
- Injuries to knees and lower extremities
- Elbow injuries
- Rib injuries
- Hip injuries
Some of the treatment options studied included the use of opioid pain medication, such as tramadol, oxycodone, and acetaminophen + codeine. Other cases used only non-steroidal anti-inflammatory medications (NSAIDs) such as diclofenac or ibuprofen. Different treatments options considered in the reviewed clinical trials were:
- Acupressure
- Muscle relaxers such as cyclobenzaprine
- Laser therapy
- Joint manipulation
- Exercise
- Massage
- Supervised rehabilitation
- Mobilization
The recent study looked at the patient’s initial response within the first two hours following the injury, and then the response at one to seven days post-injury. The markers looked at were relief of pain, treatment satisfaction, physical function, and symptom relief.
Opiates Were Never the Best Option
Under no circumstances did the reviewers find that the use of opioids resulted in better outcomes than the use of NSAIDs. They also found that the risks associated with the use of opioids were greater, including neurological issues, overuse, and adverse gastroenterological events.
Topical NSAIDs were determined to be the most effective and safest treatments.
Guidelines Failed to Include Several Alternative Treatments
Perhaps not surprisingly, given that this was a study performed by traditional medicine groups, a number of alternative treatment options were not included in the review. For instance, millions of pain sufferers have reported good symptom relief and few side effects with the use of medical marijuana, but that was not a pain relief option considered in the study.
Another “alternative” treatment not considered in the review was acupuncture, a modality that has been used for thousands of years and has been found to be highly effective for pain relief without side effects.
In any event, the review supports the idea that other options besides opiates should be considered first in the quest for relief of acute musculoskeletal pain.
Below is a YouTube video posted by Today discussing alternate therapies for low back pain.
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