Soft tissue injuries are common and one of the Cochrane Reviews of their treatment was updated in August 2020 to assess the effects of different types of pain killer. Here's Peter Jones from Auckland City Hospital in New Zealand to outline the latest findings.
Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Soft tissue injuries are common and one of the Cochrane Reviews of their treatment was updated in August 2020 to assess the effects of different types of pain killer. Here's Peter Jones from Auckland City Hospital in New Zealand to outline the latest findings.
Pete: Soft tissue injuries include things such as sprains, strains and bruises and are often painful, especially in the first couple of days. Treatment with oral non-steroidal anti-inflammatory drugs (or NSAIDs) is often recommended because of the inflammatory response after injury. However, it’s not clear whether reducing inflammation confers any benefit or whether the NSAID effect on inflammation makes a meaningful difference in this setting, given that inflammation is part of the normal healing process. Other drugs, that don’t have local anti-inflammatory effects are also commonly given for soft tissue injury and our review investigates whether there are any differences in pain relief, swelling, return to function, re-injury or adverse effects of anti-inflammatory compared to other oral pain killers.
We found 20 randomised trials involving a little over 3300 participants, who were mostly young adults, with slightly more males than females included. Very few people were older than 65 and only three studies looked specifically at children. Eleven of the studies compared NSAIDs to paracetamol, six studies compared them to opioids and four compared them to a combination of paracetamol and opioids. The studies reported outcomes from one hour up to two weeks after treatment.
Starting with pain relief, the studies found no difference between NSAIDs and any of the other drugs at any time measured. This evidence was high certainty for paracetamol at up to three days and low certainty after a week. For opioids, the evidence was moderate certainty after the first hour and low certainty later. While all the evidence was very low certainty for the combination of paracetamol and opioid at all times, because of the small number of people in those trials.
There was also no difference between NSAIDs and other drugs for swelling, although this evidence was also very low certainty, because of small numbers.
For return to function after one week, there was very low certainty evidence of no difference between NSAIDs and paracetamol or the combination of paracetamol and opioid. But there was low certainty evidence from two studies that more people returned to function after one week if they were given an NSAID rather than an opioid.
Finally, there was low certainty evidence that NSAIDs may increase unwanted gastrointestinal adverse effects compared to paracetamol, but moderate certainty evidence that NSAIDs have fewer gastrointestinal or neurological adverse effects than opioids. The evidence for a reduction in these adverse effects for NSAIDs compared to the combination of opioid and paracetamol was very low certainty, once again because of small sample sizes.
In summary, our review found no difference between NSAIDs and other pain killers for pain relief or swelling for strains, sprains, and bruises in younger people. However, the lack of strong evidence on return to function, adverse effects and re-injury, which was not reported in any of the studies, and the poor coverage of age groups, means that we still need more studies to fill these gaps.
Monaz: If you would like to read more about the evidence that is available and see future updates of the review if those new studies get done, you can find the full review at Cochrane Library dot com with a simple search for 'NSAIDS and soft tissue injury'.