From the Guidelines
Hand pain can be effectively managed with a combination of rest, over-the-counter pain medications, and gentle stretching exercises, as recommended by recent guidelines 1. For immediate relief, taking ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours or acetaminophen (Tylenol) 500-1000mg every 6 hours as needed, not exceeding maximum daily doses (3200mg for ibuprofen, 3000mg for acetaminophen), is advised 1. Apply ice for 15-20 minutes several times daily during the first 48 hours, then switch to heat therapy. Rest your hand and avoid activities that worsen the pain. Gentle stretching exercises, like opening and closing your fist slowly or rotating your wrists, can help maintain mobility. If pain persists beyond two weeks, worsens significantly, is accompanied by swelling or redness, or follows an injury, seek medical attention as it could indicate arthritis, carpal tunnel syndrome, tendonitis, or a fracture 1. These conditions may require specific treatments like splinting, physical therapy, or prescription medications. Some key points to consider in managing hand pain include:
- The use of oral NSAIDs should be based on individual patient characteristics and should be used at the lowest effective dose and for the shortest duration 1.
- In patients with increased gastrointestinal risk, non-selective NSAIDs plus a gastroprotective agent, or a selective COX-2 inhibitor should be used 1.
- SYSADOA (for example, glucosamine, chondroitin sulphate, avocado soybean unsaponifiables, diacerhein, intra-articular hyaluronan) may give symptomatic benefit with low toxicity, but effect sizes are small, and clinically relevant structure modification and pharmacoeconomic benefits have not been established 1.
- Intra-articular injection of long-acting corticosteroid is effective for painful flares of OA, especially trapeziometacarpal joint OA 1. Given the potential for hand pain to result from various underlying conditions, it is crucial to seek medical attention if the pain persists or worsens over time, to ensure appropriate diagnosis and treatment 1.
From the Research
Hand Pain Overview
- Hand pain is a common condition with a prevalence of 9.7% in men and 21.6% in women, causing significant morbidity and disability 2.
- It can interfere with independence and activities of daily living, and carries a significant cost to individuals and the healthcare system 2.
Causes and Management of Hand Pain
- Osteoarthritis is the most common chronic hand pain syndrome, affecting about 16% of the population, and its management may involve injection therapy, including steroid injections and hyaluronic acid (HA) injections 2.
- Carpal tunnel syndrome, a compressive neuropathy, may be temporarily relieved with injection therapy, and US-guidance can provide significant improvement 2.
- Other conditions, such as stenosing tenosynovitis, De Quervain's tenosynovitis, and gout, may also be managed with injection therapy, including corticosteroid (CS) injections 2.
Pharmacologic Therapy for Hand Pain
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain, including hand pain 3.
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries, including hand pain 3.
- Ibuprofen/acetaminophen fixed-dose combination is an alternative to opioids in the management of common pain types, including hand pain, with a range of potential benefits 4.
Neuropathic Hand Pain
- Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, pregabalin, and gabapentin are proposed as first-line treatments for neuropathic pain, including hand pain 5.
- Lidocaine plasters and capsaicin high concentration patches are recommended as second-line treatments for peripheral neuropathic pain, including hand pain 5.