What is the medical management of bursitis?

From the Guidelines

The medical management of bursitis primarily involves rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs). For initial treatment:

• Rest the affected area and avoid activities that worsen pain.
• Apply ice for 15-20 minutes every 4-6 hours to reduce inflammation.
• Take over-the-counter NSAIDs such as ibuprofen (400-800 mg every 6-8 hours) or naproxen (220-440 mg every 12 hours) for pain and inflammation, as suggested by 1. If symptoms persist after 1-2 weeks:
• Consider a corticosteroid injection (e.g., methylprednisolone 40-80 mg) into the bursa, administered by a healthcare professional.
• Use physical therapy exercises to improve flexibility and strengthen surrounding muscles, which is in line with the personalized management plan approach recommended by 1. For chronic cases:
• Continue NSAIDs as needed.
• Use supportive devices (e.g., knee pads for prepatellar bursitis) to reduce pressure on the affected area.
• Consider lifestyle modifications to prevent recurrence, such as education and self-management support, as part of a stepped-care approach 1. This approach targets inflammation, which is the primary cause of pain and discomfort in bursitis, and is supported by the most recent and highest quality study 1, which emphasizes the importance of a personalized management plan and a stepped-care approach.

From the FDA Drug Label

Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. Naproxen may also be used The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required. The initial total daily dose should not exceed 1250 mg of naproxen. Thereafter, the total daily dose should not exceed 1000 mg of naproxen.

The medical management of bursitis may include the use of naproxen with a recommended starting dose of 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required, with a maximum initial total daily dose of 1250 mg and a maximum total daily dose thereafter of 1000 mg 2.

• Key considerations include:
  • Using the lowest effective dose for the shortest duration consistent with individual patient treatment goals
  • Potential benefits and risks of naproxen and other treatment options should be carefully considered 2

From the Research

Medical Management of Bursitis

The medical management of bursitis typically involves a combination of non-pharmacological and pharmacological interventions.

• Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain and inflammation 3, 4, 5, 6, 7.
• Physiotherapy is also recommended to improve range of motion and strengthen surrounding muscles 3, 4.
• In some cases, injections of corticosteroid may be used to reduce inflammation and relieve pain 3.
• Mesotherapy, a minimally invasive technique involving subcutaneous injections of bioactive substances, has also been shown to be effective in managing anserine bursitis 3.
• Kinesiotaping has been found to be more effective than naproxen plus physical therapy in reducing pain and swelling in patients with pes anserinus tendino-bursitis 4.
• Topical NSAIDs, such as diclofenac and ketoprofen, have been shown to be effective in reducing pain in patients with osteoarthritis, with a number needed to treat (NNT) of 9.8 and 6.9, respectively 6.

Pharmacological Interventions

Pharmacological interventions for bursitis include:

• NSAIDs, which work by inhibiting the synthesis of prostaglandins, thereby reducing pain and inflammation 5, 6, 7.
• Corticosteroid injections, which can help reduce inflammation and relieve pain 3.
• Topical NSAIDs, which can provide localized pain relief with minimal systemic side effects 6.

Non-Pharmacological Interventions

Non-pharmacological interventions for bursitis include:

• Physiotherapy, which can help improve range of motion and strengthen surrounding muscles 3, 4.
• Kinesiotaping, which can help reduce pain and swelling in patients with pes anserinus tendino-bursitis 4.
• Mesotherapy, which can help modulate the pharmacokinetics of injected substances and prolong their effects at a local level 3.