Oral non‐steroidal anti‐inflammatory drugs vs other oral pai | Figure 1

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Oral non‐steroidal anti‐inflammatory drugs vs other oral pain killers for sprains, strains & bruises

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Introduction and aims

Sprains, strains, and bruises are common injuries, and people with these injuries often require pain relief, given as a tablet or capsule that is swallowed (oral). Many types of oral painkillers are available to treat such injuries. We wanted to know whether there were any differences in people's pain, swelling, function, or unwanted side effects when sprains, strains, and bruises were treated with oral non‐steroidal anti‐inflammatory drugs (NSAIDs, e.g. ibuprofen) compared with paracetamol, opioids (e.g. codeine), complementary or alternative medicines, or combinations of these.

This is an update of a Cochrane review published in 2015.

What did we do?

We searched medical databases up to January 2020 for studies that compared NSAIDs with other painkillers in people with sprains, strains, and bruises. Study participants could be any age. We assessed the included studies to judge the reliability (certainty) of the evidence. We categorised the evidence as being of high, moderate, low, or very low certainty. High certainty means we are confident in the evidence, moderate certainty means we are fairly confident, low or very low certainty means that we are unsure or very unsure of the reliability of the evidence.

Results of our search and description of studies

We included 20 studies, with 3305 participants. Seven studies included people with ankle sprain only. Three studies included children only. Most of the participants of the other studies were young adults, and there were slightly more men than women. Few participants were aged over 65 years. Eleven studies compared NSAIDs with paracetamol, six studies compared NSAIDs with opioids, and four studies compared NSAIDs with paracetamol combined with an opioid. Studies reported outcomes at times varying from one hour after taking the medication, up to 10 to 14 days.

Main results

There is no difference between NSAIDs and paracetamol in pain after one to two hours, or after two to three days (high‐certainty evidence), and there may be no difference after a week or more (low‐certainty evidence). There is low‐certainty evidence that NSAIDs may make little difference to swelling after a week or more. We are uncertain whether NSAIDs make a difference to return to function after a week or more (very low‐certainty evidence). There is low‐certainly evidence that NSAIDs may slightly increase unwanted side effects related to the gut.

There is probably no difference between NSAIDs and opioids in pain at one hour (moderate‐certainly evidence), and there may be no difference four or seven days after taking medication (low‐certainty evidence). We are uncertain whether NSAIDs make a difference to swelling after 10 days (very low‐certainty evidence). There is low‐certainty evidence that NSAIDs may increase return to function in 7 to 10 days. There is moderate‐certainty evidence that NSAIDs probably result in fewer unwanted side effects, such as nausea and dizziness, compared with opioids.

The evidence suggests that there is little or no difference between NSAIDs and paracetamol combined with opioids in pain, swelling, return to function, or unwanted side effects. However, the evidence was very low certainty, so we are uncertain of these results.

No studies reported the risk of re‐injury after treatment.

We found no studies comparing NSAIDs with complementary or alternative medicines.

Conclusions

The body of evidence to date has found no difference between NSAIDs and other pain killers for pain relief for strains, sprains, and bruises in younger people. However, we need more, and better evidence on return to function and unwanted side effects in all age groups, particularly in older people.

Read the full Cochrane Review here

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The Cochrane Review "Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low birth weight infants" has been updated and the conclusions changed. "Moderate‐certainty evidence suggests that there is probably little or no difference in effectiveness between paracetamol and ibuprofen; low‐certainty evidence suggests that there is probably little or no difference in effectiveness between paracetamol and indomethacin; low‐certainty evidence suggests that prophylactic paracetamol may be more effective than placebo/no intervention; low‐certainty evidence suggests that early paracetamol treatment may be more effective than placebo/no intervention; low‐certainty evidence suggests that there is probably little or no difference between late paracetamol treatment and placebo, and probably little or no difference in effectiveness between the combination of paracetamol plus ibuprofen versus ibuprofen alone for the closure of PDA after the first course of treatment. The majority of neonates included in these studies were of moderate preterm gestation. Thus, establishing the efficacy and safety of paracetamol for PDA treatment in extremely low birth weight (ELBW: birth weight < 1000 grams) and extremely low gestational age neonates (ELGANs < 28 weeks' gestation) requires further studies." www.cochranelibrary.com

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