• Clinical Practice Guideline

    Management of Acute Musculoskeletal Pain

    Management of Acute Pain from Non-Low Back, Musculoskeletal Injuries in Adults

    (Jointly Developed, August 2020)

    The guideline was developed by the American College of Physicians and the American Academy of Family Physicians.  

    Key Recommendations

    • Topical NSAIDs, with or without menthol gel, should be used as first line therapy for adults with acute pain from non-low back, musculoskeletal injuries.
    • Oral NSAIDs and acetaminophen may be considered as options for pharmacologic treatment for adults with acute pain from non-low back, musculoskeletal injuries. Non-pharmacologic options for patients include specific acupressure or transcutaneous electrical nerve stimulation (TENS).
    • Opioids, including tramadol, should not be used as first line treatments for adults with acute pain from non-low back musculoskeletal injuries. Severity of the injury and patient intolerance of other treatments, and potential harms should be considered before initiating treatment with opioids. 

    These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.