From the Guidelines
The best next step in treatment for thumb pain likely due to overuse is to start with conservative management, prioritizing topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy, as recommended by the American College of Physicians and American Academy of Family Physicians 1. This approach is supported by the most recent and highest quality study, which suggests that topical NSAIDs can reduce or relieve symptoms, including pain, and improve physical function and patient satisfaction.
Key Components of Conservative Management
- Rest and activity modification to avoid movements that aggravate the pain
- Apply ice to the affected area for 15-20 minutes several times daily to reduce inflammation
- Consider using a thumb spica splint to immobilize and rest the joint, wearing it during activities and at night for 2-4 weeks
- Gentle stretching and strengthening exercises can be initiated once acute pain subsides
Additional Considerations
- If symptoms persist beyond 2-3 weeks despite these measures, seek medical evaluation as the pain could be due to conditions like De Quervain's tenosynovitis, carpometacarpal osteoarthritis, or trigger thumb that may require additional interventions such as corticosteroid injections or physical therapy 1.
- Oral NSAIDs or acetaminophen may be considered for pain relief, but with caution and under medical guidance 1.
- Opioids should be avoided due to the risk of opioid use disorder and lack of evidence supporting their effectiveness for acute musculoskeletal pain 1.
From the Research
Treatment Options for Thumb Pain
The patient's thumb pain is likely due to overuse, and the best next step in treatment can be determined by considering the following options:
- Topical nonsteroidal anti-inflammatory drugs (NSAIDs) as a first-line treatment for non-low back, musculoskeletal injuries, including thumb pain 2
- Oral NSAIDs as an alternative, although they may have more gastrointestinal side effects compared to topical NSAIDs 3
- Acetaminophen as a well-tolerated option, but with caution in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 2
Considerations for Treatment
When choosing a treatment option, consider the following:
- The patient's medical history, including any previous adverse reactions to NSAIDs or other medications
- The severity of the thumb pain and the patient's treatment expectations
- The potential risks and benefits of each treatment option, including the risk of gastrointestinal side effects with oral NSAIDs 3
- The importance of close adherence to dosing regimens and monitoring, particularly for patients with previous adverse reactions to NSAIDs 3