From the Guidelines
DMSO is not recommended for treating connective tissue injuries due to limited scientific evidence and potential side effects, and instead, rest, cold application, and limiting the use of the injured extremity are recommended as the mainstay of treatment. The most recent and highest quality study, 1, published in 2024 in the journal Circulation, suggests that the mainstay of treatment for strains and sprains is rest and limiting the use of the injured extremity, and cold application can acutely decrease pain and swelling in joint sprains and muscle strains.
Key Points
- Rest and limiting the use of the injured extremity are crucial in treating connective tissue injuries
- Cold application can decrease pain and swelling, but its duration should be limited to 20 to 30 minutes for 3 to 4 times daily
- DMSO is not FDA-approved for most medical uses and its effectiveness in treating connective tissue injuries is not supported by strong evidence
- Medical supervision is recommended before using any treatment for connective tissue injuries Some studies, such as 1, published in 2020 in the journal Annals of Internal Medicine, provide guidelines for the management of acute pain from non-low back, musculoskeletal injuries, but they do not specifically address the use of DMSO for connective tissue injuries.
Treatment Considerations
- Nonpharmacologic interventions, such as specific acupressure and transcutaneous electrical nerve stimulation, may be considered for reducing pain and improving physical function
- Opioids, including tramadol, are not recommended for treating acute pain from non-low back, musculoskeletal injuries due to the risk of opioid use disorder
- The estimated annual cost of treating musculoskeletal injuries is significant, and treatment options should be chosen based on the best available evidence of benefits and harms.
From the Research
Effects of Dimethyl Sulfoxide (DMSO) on Treating Connective Tissue Injuries
- DMSO provides rapid, temporary, relief of pain in patients with arthritis and connective tissue injuries 2
- However, claims for anti-inflammatory effects or acceleration of healing are currently unwarranted 2
- Dermal application of DMSO seems to be beneficial for palliative treatment, but its use should not exclude standard anti-inflammatory agents 2
Comparison with Other Treatments
- Non-steroidal anti-inflammatory drugs (NSAIDs) have a mild effect on relieving symptoms and are potentially deleterious to tissue healing 3
- Paracetamol is the analgesic of choice for most soft-tissue injury, with similar efficacy to NSAIDs but a lower side-effect profile 3
- Cryotherapy may be recommended in the first 6 hours following an injury to reduce pain, but its use beyond 12 hours post-injury is uncertain and may interfere with tissue healing and regeneration 4
Wound Healing and Connective Tissue Repair
- The restoration of dermal loss is by scarring, where a new cell population resides in a new connective tissue matrix 5
- The maturation of scar depends on the character of its resident cell populations, the quality of deposited connective tissue, and the interactions between those components 5
- Early mobilization, guided by the pain response, promotes a more rapid return to full functional recovery 6