In a report detailing new clinical guidelines for treating non-low back musculoskeletal injuries, the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) now recommends NSAIDs as a first-line treatment for pain. The report also encourages doctors to avoid opioids whenever possible.
It is not clear whether or not the new guidelines are specifically intended to target opioid use. Even if not, fewer opioid prescriptions should be observed.
d as doctors adhere to the guidance. The end result should be fewer opioid addictions resulting from legitimate prescription use.
Musculoskeletal Injuries Are Common
A Medical Xpress article detailing the new guidelines explains that musculoskeletal injuries are fairly common. The article, originally produced by the ACP, sites 2010 data showing that more than 65 million healthcare visits during that year were attributed to such injuries. Furthermore, some 80% of all injuries treated in GP offices were musculoskeletal in nature.
Opioid prescriptions would seem a bit extreme for even moderate musculoskeletal injuries. Even so, the new guidelines make it clear that oral and topical NSAIDs are a better choice. ACP president Jacqueline W. Fincher, MD says that “there are a number of recommended interventions that are not opioids to choose from, and topical NSAIDs should be the first line of treatment.”
Topical NSAIDs First
The guidelines go on to say that topical NSAIDs are the best first-line treatment for pain related to non-low back musculoskeletal injuries. Evans extensively shows that topical NSAIDs are among the most effective options for symptom relief, pain reduction, restoration of physical function, and patient satisfaction.
Unlike opioids, NSAIDs do not pose any risk of addiction. That automatically makes them better if they can be used to treat pain as successfully as opioids. When topical NSAIDs do not work as well as doctors hope, there are other options that can be looked at before opioids.
Some musculoskeletal injuries can be successfully treated with steroid injections. Lone Star Pain Medicine, a Texas clinic that specializes in pain management, will often suggest corticosteroid injections to patients for whom NSAIDs have proven unhelpful.
Corticosteroids can reduce inflammation and aid the healing process simultaneously. Reducing inflammation reduces pain as well. Best of all, the effects of a corticosteroid injection can last two or three months under normal circumstances. The effects can last longer when injections are combined with physical therapy and other treatments.
Regenerative Medicine Options
Though the APA and AAFP guidance makes no mention of it, regenerative medicine also offers options. Regenerative medicine procedures include things like platelet-rich plasma (PRP) injections, stem cell injections, and prolotherapy.
The jury is still out on whether or not regenerative medicine is appropriate for musculoskeletal injuries. Proponents cite anecdotal data while critics claim clinical data is insufficient. And yet, patients all across the country seem more willing to give regenerative medicine a try.
It should be noted that the FDA already allows for PRP and stem cell injections as long as the injected material is autologous and minimally manipulated. Autologous material is material taken from the patient being treated, guaranteeing there is no risk of rejection.
In the end, anything that helps reduce opioid prescriptions is a good thing. Opioids are highly addictive and potentially dangerous. As such, reducing the total number of opioid prescriptions written by doctors is a goal worth pursuing. Perhaps this new guidance on NSAIDs as a first-line treatment for musculoskeletal injuries will lead to bigger and better things.
As a patient, expect your doctor to recommend NSAIDs as a first-line treatment moving forward. Hopefully, opioids will be relegated to a last resort option.