The American Academy of Family Physicians and The American College of Physicians have developed the following guidelines to provide clinical recommendations on the nonpharmacologic and pharmacologic management of acute pain from non–low back musculoskeletal injuries. The guidance is based on the currently available evidence about benefits and harms, taken in the context of costs and patient values and preferences. These guidelines are for all clinicians, and the adults suffering from acute pain from non–low back, musculoskeletal injuries:

Recommendation 1:

Clinicians should treat patients with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as a therapy to reduce or relieve symptoms, including pain, improving physical function, and the patient’s overall treatment satisfaction.

Recommendation 2a:

Clinicians can treat patients with oral NSAIDs to reduce or relieve symptoms, including pain, improve physical function, or reduce pain with oral acetaminophen.

Recommendation 2b:

Clinicians can treat patients with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain.

Recommendation 3:

Clinicians should not treat patients with acute pain from non–low back, musculoskeletal injuries with opioids, including tramadol.

Acute musculoskeletal injuries are common and are most frequently treated in outpatient settings, lasting less than four weeks. In the United States, approximately one-fifth of patients presenting with pain receive an opioid prescription. As of 2015, two million patients had an opioid use disorder involving prescription opioids, although prescribing rates have decreased in recent years.

Ref: https://www.acpjournals.org/doi/10.7326/M19-3602