What is the treatment of choice for generalized musculoskeletal (muscle and skeletal) pain?

From the Guidelines

The treatment of choice for generalized musculoskeletal pain is topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy. This recommendation is based on a strong recommendation with moderate-certainty evidence from the American College of Physicians and American Academy of Family Physicians 1.

Key Considerations

• Topical NSAIDs are preferred over oral NSAIDs due to their localized action and reduced risk of systemic side effects.
• Oral NSAIDs or acetaminophen may be considered as alternative options if topical NSAIDs are not effective, as suggested by a conditional recommendation with moderate-certainty evidence 1.
• Nonpharmacologic interventions such as specific acupressure or transcutaneous electrical nerve stimulation may also be considered, although the evidence is of low certainty 1.
• Opioids, including tramadol, are not recommended for the treatment of acute musculoskeletal pain due to their potential for abuse and lack of evidence supporting their effectiveness in this context, as stated in a conditional recommendation with low-certainty evidence 1.

Additional Recommendations

• Patients should be encouraged to engage in gentle stretching exercises and maintain proper hydration to help manage their symptoms.
• Adequate rest and stress management techniques may also be beneficial in reducing muscle tension and improving overall quality of life.
• If symptoms persist or worsen, medical evaluation is necessary to rule out underlying conditions that may require specific treatment.

Evidence Summary

The American College of Physicians and American Academy of Family Physicians guideline provides the most recent and highest-quality evidence for the management of acute musculoskeletal pain in adults 1. This guideline emphasizes the importance of nonpharmacologic and pharmacologic interventions in reducing symptoms and improving patient outcomes. By prioritizing topical NSAIDs as first-line therapy, clinicians can provide effective and safe treatment for patients with generalized musculoskeletal pain.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual crums and other types of short-term pain Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout

The treatment of choice for generalized musculoskeletal (muscle and skeletal) pain is NSAIDs, such as naproxen.

• Naproxen has been shown to be effective in treating various types of musculoskeletal pain, including rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis 2.
• NSAIDs can cause side effects, such as stomach pain, diarrhea, and dizziness, and should be used with caution 2.

From the Research

Treatment Options for Generalized Musculoskeletal Pain

• The treatment of choice for generalized musculoskeletal pain is not explicitly stated in the provided studies, but some studies suggest that acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 3.
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 3.
• Naproxen, acetaminophen, and ibuprofen are commonly used pain medications for controlling side effects during initiation of IFN beta-1a therapy and during its ongoing use for relapsing-remitting multiple sclerosis 4.
• A network meta-analysis found that ibuprofen and diclofenac-K may be the two best treatment options for patients with episodic tension-type headache, which is a type of musculoskeletal pain 5.

Efficacy and Safety of Treatment Options

• Acetaminophen is well tolerated, but lower doses should be used in patients with advanced hepatic disease, malnutrition, or severe alcohol use disorder 3.
• Nonselective NSAIDs are effective but should be used with caution in patients with a history of gastrointestinal bleeding, cardiovascular disease, or chronic renal disease 3.
• Naproxen and ibuprofen were more effective than acetaminophen in minimizing physical side effects of IFN beta-1a therapy 4.
• The adverse event rates of all analgesics were no higher than those of placebo, except for ketoprofen 5.

Comparison of Treatment Options

• A study compared the efficacy and safety of paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults, but did not provide information on generalized musculoskeletal pain 6.
• Another study reviewed the data supporting the use of OTC naproxen to effectively treat a variety of types of acute pain, including dysmenorrhea, headache, and dental pain 7.