ACP, AAFP issue joint guideline on non-low back pain from musculoskeletal injuries in adults
The College and the American Academy of Family Physicians (AAFP) recommend topical NSAIDs as first-line therapy for this type of pain and advise against the use of opioids.
Physicians should use topical nonsteroidal anti-inflammatory drugs (NSAIDs), with or without menthol gel, as first line-therapy for acute pain from non-low back musculoskeletal injuries, according to a new evidence-based guideline.
The guideline, jointly developed by ACP and the American Academy of Family Physicians (AAFP), focused on non-low back pain, since low back pain was specifically addressed in a separate ACP guideline that has also been endorsed by AAFP. The new guideline was published Aug. 18 by Annals of Internal Medicine.
In addition to the first-line recommendation to treat patients with topical NSAIDs (strong recommendation; moderate-certainty evidence), the guideline said:
- Physicians should treat patients with acute pain from non-low back musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, and to improve physical function, or with oral acetaminophen to reduce pain (conditional recommendation; moderate-certainty evidence).
- Physicians should treat patients with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain (conditional recommendation; low-certainty evidence).
- Physicians should avoid prescribing opioids, including tramadol, for this type of pain (conditional recommendation; low-certainty evidence).
The guidance is based on current best available evidence about benefits and harms, taken in the context of costs and patient values and preferences. It was published along with a systematic evidence review on the comparative efficacy and safety of nonpharmacologic and pharmacologic management and a systematic review on the predictors of prolonged opioid use.