What medications are recommended for treating a sprain?

Medications for Sprain Treatment

NSAIDs are recommended as first-line medication for sprains, with acetaminophen being an equally effective alternative with fewer side effects. 1

First-Line Medication Options

NSAIDs

• Oral NSAIDs reduce pain in the short term (<14 days) without significantly increasing adverse events compared to placebo 2
• Common options include:
  • Naproxen: 500mg initially, then 250mg every 6-8 hours (not exceeding 1250mg in first 24 hours) 1, 3
  • Diclofenac: Shows superior results for pain during motion compared to ibuprofen 2, 1
  • Celecoxib: 200mg twice daily; non-inferior to non-selective NSAIDs with potentially fewer GI side effects 2

Acetaminophen

• Equally effective as NSAIDs for pain relief 2, 4
• Recommended dosage: 1000mg every 6 hours (not exceeding 4000mg daily) 1
• Advantage: Does not interfere with the natural healing process 5
• Consider as first choice for patients with contraindications to NSAIDs 1, 5

Application Method

Oral vs. Topical

• Topical NSAIDs (particularly diclofenac gel) can be considered for localized pain relief with fewer systemic side effects 1
• Oral administration provides more systemic relief but with increased risk of side effects 2

Important Considerations

NSAID Cautions

• May delay natural healing by suppressing inflammation necessary for tissue recovery 2, 5
• Contraindications: History of GI bleeding, heart disease, renal impairment 3
• Side effects: Stomach ulcers, bleeding, fluid retention, increased blood pressure 3

Medication Timing

• Begin medication within 24-48 hours of injury for optimal effect 1
• Continue for 7-10 days as needed for pain control 2

Adjunctive Treatments

PRICE Protocol

• Protection: Avoid activities that cause pain
• Rest: Limit weight-bearing as needed
• Ice: Apply for 15-20 minutes every 2-3 hours
• Compression: Use elastic bandage
• Elevation: Keep injured area above heart level

Note that while RICE (Rest, Ice, Compression, Elevation) alone has limited evidence for effectiveness 2, it remains part of standard practice when combined with appropriate medication.

Functional Treatment

• Begin early functional rehabilitation within 48-72 hours of injury 1
• Progressive strengthening exercises and proprioceptive training are crucial for recovery and preventing recurrence 1

Special Populations

• Elderly: Consider acetaminophen first due to lower risk of side effects 3, 5
• Patients with GI risk factors: Use acetaminophen or add gastroprotective agent if NSAID is necessary 3
• Athletes: May benefit from semi-rigid ankle support in addition to medication 1

Duration of Treatment

• Most sprains respond to 7-10 days of medication 2, 1
• Discontinue NSAIDs as soon as pain allows to minimize potential side effects 3

Remember that medication is just one component of sprain management, with functional rehabilitation being equally important for optimal recovery and prevention of recurrence.