Randomized Double-Blind Trial Comparing Oral Paracetamol and Oral Nonsteroidal Antiinflammatory Drugs for Treating Pain After Musculoskeletal Injury

Woo, William W.K.; Man, S. Y.; Lam, P. M.; Rainer, Timothy Hudson

doi:10.1016/j.annemergmed.2005.01.023

Cited by 51 publications

(42 citation statements)

References 11 publications

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“…In addition, unlike our study, only a small number of patients had fractures. 15 One small, nonrandomized 3-arm trial (76 patients) compared the effect of "standard care" (ice and elevation), "standard care" plus 10 mg/kg ibuprofen, and "standard care" plus distraction on pain relief in children with fractures. Interestingly, this trial found that ibuprofen added no pain relief benefit to standard care, although distraction was beneficial.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] One recent large ED-based study found no difference in pain relief between adult patients treated with paracetamol, indomethacin, diclofenac, or paracetamol combined with either nonsteroidal medication. 15 The objective of this study was to determine which of 3 oral medications, acetaminophen, ibuprofen or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the ED with acute musculoskeletal traumatic injuries.…”

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confidence: 99%

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A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

Clark

Plint

Correll³

et al. 2007

Pediatrics

177

143

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

Clark

Plint

Correll³

et al. 2007

Pediatrics

177

143

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“…Taken during this stage, NSAIDs reduce pain and promote function following injury6 and there is evidence to suggest that short-term use limits the negative effects of NSAIDs on tissue-level healing 2122. Athletes with a history of side effects or risk factors for side effects with NSAIDs should be provided lower-risk non-NSAID analgesia such as paracetamol, which may be as effective as NSAIDs at treating acute musculoskeletal pain 23. Alternatively, at-risk athletes may be offered the option of taking a concomitant protective agent, such as a proton pump inhibitor for gastroprotection 9.…”

Section: Recommendations For Nsaid Use By Athletesmentioning

confidence: 99%

Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes: Figure 1

Warden

2009

Br J Sports Med

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Superstitions and rituals are commonplace in sports and range from simple activities such as each player touching a special inanimate object before entering the field of play to more extreme behaviours such as not washing a uniform or wearing the same underwear during a winning streak. These practices are relatively harmless and may reduce precompetition anxiety, but a concerning ritual that has recently developed in sports is the prophylactic use of non-steroidal antiinflammatory drugs (NSAIDs). ATHLETES MISUSE NSAIDS PROPHYLACTIC USE OF NSAIDS IS NOT SAFEThe prolonged prophylactic use of NSAIDs by athletes is a major concern as use of these agents is not without consequence. NSAIDs exert their antiinflammatory and analgesic effects via inhibition of the cyclooxygenase (COX) isozymes and, in particular, the inhibition of COX-2. The COX isozymes catalyse the rate-limiting step in the formation of prostaglandins from arachidonic acid. By inhibiting COX-2-mediated prostaglandin synthesis immediately before or following injury, NSAIDs can reduce musculoskeletal pain and accelerate return of function. 7However, the prolonged prophylactic use of NSAIDs by athletes is unsafe. In addition to participating in inflammatory processes, prostaglandins synthesised in response to COX activity have important gastrointestinal and cardiovascular functions. As a result, NSAID use is associated with elevated risk of adverse effects within these systems, irrespective of the relative COX isozyme selectively of the agent. [8][9][10] As the adverse gastrointestinal and cardiovascular effects associated with NSAIDs become more pronounced with increased duration of use, athletes risk serious side effects by using NSAIDs prophylactically for prolonged periods. This is further compounded in some athletes as approximately 10% of those who use NSAIDs take up to five different compounds concomitantly. 4 11 PROPHYLACTIC USE OF NSAIDS MAY NEGATIVELY IMPACT MUSCULOSKELETAL PATHOLOGYA paradoxical consequence of the prophylactic use of NSAIDs by athletes is that these agents can compromise the musculoskeletal system.12 NSAIDs taken before activity may mask pain and thus cause athletes to inadvertently allow pathology to progress. Even more significantly, NSAIDs' inhibitory effects on the COX isozymes and prostaglandins may impede the synthesis of the extracellular matrix (ie, collagen) that confers strength to tissue. This has two important ramifications for athletes. First, COX-2 and prostaglandins are important mediators in the responsiveness and subsequent adaptation of connective tissues to mechanical stimuli. 13 14 Athletes who regularly take NSAIDs before exercise may have reduced tissue adaptation to prevailing loads potentially predisposing them to future injury. Second, prolonged prophylactic use of NSAIDs has the potential to reduce the rate of matrix production and subsequent tissue repair following microscopic or macroscopic injury. This has been shown most convincingly following fracture where prolonged NSAID use delayed healing, 15...

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“…NSAID have known anti-inflammatory, analgesic, antipyretic and antithrombotic effects,1 although their in-vivo effects in treating musculoskeletal injuries in humans remain largely unknown. NSAID analgesic action does not appear to be significantly greater than paracetamol for musculoskeletal injury2 but they have a higher risk profile, with side-effects including asthma exacerbation, gastrointestinal and renal side-effects, hypertension and other cardiovascular diseases. Evidence-based working groups on pain management recommend using regular paracetamol as first-line treatment for acute3 and chronic musculoskeletal pain 4.…”

mentioning

confidence: 98%

Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use: Table 1

Paoloni

Milne²,

Orchard

et al. 2009

Br J Sports Med

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Introduction:Non-steroidal anti-inflammatory drugs (NSAID) are commonly used in sports medicine. NSAID have known anti-inflammatory, analgesic, antipyretic and antithrombotic effects, although their in-vivo effects in treating musculoskeletal injuries in humans remain largely unknown. NSAID analgesic action is not significantly greater than paracetamol for musculoskeletal injury but they have a higher risk profile, with side-effects including asthma exacerbation, gastrointestinal and renal side-effects, hypertension and other cardiovascular diseases.Discussion:The authors recommend an approach to NSAID use in sports medicine whereby simple analgesia is preferentially used when analgesia is the primary desired outcome. However, based both on the current pathophysiological understanding of most injury presentations and the frequency that inflammation may actually be a component of the injury complex, it is premature to suppose that NSAID are not useful to the physician managing sports injuries. The prescribing of NSAID should be cautious and both situation and pathology specific. Both dose and duration minimisation should be prioritised and combined with simple principles of protection, rest, ice, compression, elevation (PRICE), which should allow NSAID-sparing. NSAID use should always be coupled with appropriate physical rehabilitation.Conclusion:NSAID are probably most useful for treating nerve and soft-tissue impingements, inflammatory arthropathies and tenosynovitis. They are not generally indicated for isolated chronic tendinopathy, or for fractures. The use of NSAID in treating muscle injury is controversial. Conditions in which NSAID use requires more careful assessment include ligament injury, joint injury, osteoarthritis, haematoma and postoperatively.

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Randomized Double-Blind Trial Comparing Oral Paracetamol and Oral Nonsteroidal Antiinflammatory Drugs for Treating Pain After Musculoskeletal Injury

Cited by 51 publications

References 11 publications

A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

A Randomized, Controlled Trial of Acetaminophen, Ibuprofen, and Codeine for Acute Pain Relief in Children With Musculoskeletal Trauma

Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes: Figure 1

Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use: Table 1

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