What over-the-counter (OTC) medications can be used for acute muscle pain?

Over-the-Counter Medications for Acute Muscle Pain

Topical NSAIDs are the most effective first-line over-the-counter treatment for acute muscle pain, followed by oral acetaminophen and oral NSAIDs. 1

First-Line OTC Options

Topical NSAIDs

• Most effective OTC option with high-certainty evidence showing superior treatment satisfaction compared to placebo (OR, 5.20) 1
• Provide significant pain reduction at both early (<2 hours) and later timepoints (1-7 days) 1
• Improve physical function (WMD, 1.66 cm on a 10-cm scale) 1
• Associated with fewer systemic side effects than oral NSAIDs 1
• Can be used with or without menthol gel for enhanced effect 1

Oral Acetaminophen

• Moderate-certainty evidence supports its use for acute muscle pain 1
• Provides significant pain reduction at both early (<2 hours) and later timepoints (1-7 days) 1
• Standard OTC dose is 650 mg per dose 2
• Well-tolerated with fewer gastrointestinal side effects than NSAIDs 1
• Use lower doses in patients with advanced liver disease, malnutrition, or severe alcohol use disorder 3

Oral NSAIDs (e.g., ibuprofen, naproxen)

• Moderate-certainty evidence shows effectiveness for acute muscle pain 1
• Provide significant pain reduction and improved physical function 1
• Available OTC at lower doses than prescription strength 3
• Use with caution in patients with history of GI bleeding, cardiovascular disease, or chronic kidney disease 3

Combination Approaches

• Acetaminophen plus ibuprofen combination has shown mixed results:
  • Some evidence suggests the combination may be more effective than either agent alone in preventing pain persistence 4
  • However, other research found no significant difference between the combination and either agent alone for acute musculoskeletal pain 5, 6

Ineffective OTC Options

• Menthol gel alone (without NSAIDs) did not show significant improvement in function compared to placebo 1
• Glucosamine did not show statistically significant pain reduction at 1-7 days compared to placebo 1
• Ibuprofen plus cyclobenzaprine combination did not show significant pain reduction or improved treatment satisfaction compared to placebo 1

Treatment Algorithm

1. Start with topical NSAIDs (with or without menthol) as first-line therapy 1

   • Apply to affected area as directed on package
   • Provides localized relief with minimal systemic absorption

2. If inadequate relief or not appropriate for topical application:

   • Use oral acetaminophen (up to 650 mg per dose) 2, 3
   • OR oral NSAIDs (ibuprofen or naproxen at OTC doses) 3
   • Consider alternating or combining these medications if single-agent therapy is insufficient 4

3. For persistent pain despite OTC options:

   • Seek medical attention for prescription-strength options or alternative treatments 3

Important Considerations

• Avoid opioids (including tramadol) for acute musculoskeletal pain - guidelines specifically recommend against their use 1
• Most studies show that benefits of OTC medications are moderate and short-term 1
• Topical capsaicin (0.035%) may provide some analgesic effect but has less evidence than NSAIDs 7
• Consider non-pharmacologic approaches (specific acupressure, TENS) as adjuncts to medication therapy 1