Practice Guidelines

Management of Acute Pain from Non–Low Back Musculoskeletal Injuries: Guidelines from AAFP and ACP


Am Fam Physician. 2020 Dec 1;102(11):697-698.

Related editorial: Management of Acute Pain from Musculoskeletal Injuries: Guidance for Family Physicians

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Topical NSAIDs are the most effective intervention for acute musculoskeletal pain other than low back pain.

• Although oral NSAIDs and acetaminophen are effective for acute pain relief, combining them does not improve effectiveness.

• Although moderately effective for pain relief, opioids increase gastrointestinal and neurologic adverse effects and lead to long-term use in 6% of people treated.

• Acupressure and TENS techniques are effective nonpharmacologic options for acute pain.

From the AFP Editors

Acute musculoskeletal pain includes any injury with pain lasting less than four weeks. Injuries include sprains, strains, soft tissue injuries, whiplash, and fractures. Between 2000 and 2010, approximately one-fifth of outpatient visits for pain received a prescription for opioids. The American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) have published guidelines based on a systematic review and network meta-analysis of 207 studies involving 32,959 patients that evaluated treatments for acute musculoskeletal pain other than low back pain.

Medication Therapy

Topical nonsteroidal anti-inflammatory drugs (NSAIDs) are the primary recommended treatment, being among the most effective medications and the only to improve all measured outcomes. Topical NSAIDs improve pain within two hours, provide sustained relief over one week, and are the most effective intervention for improving physical function. They also lead to symptom relief and patient satisfaction more than oral NSAIDs. No adverse effects are more common with topical NSAIDs than with placebo. The effectiveness of topical NSAIDs with menthol gel is similar to that of topical NSAIDs alone.

Oral NSAIDs are recommended as a secondary medical intervention. Oral NSAIDs also reduce pain at two hours and over one week and increase physical function and symptom relief, although to a lesser extent than topical NSAIDs. Oral NSAIDs do not increase patient satisfaction

Author disclosure: No relevant financial affiliations.

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at



Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

More in AFP

More in Pubmed


Jan 2022

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article