From the FDA Drug Label
Mild to moderate pain: 400 mg every 4 to 6 hours as necessary for relief of pain. The recommended dose for pain management in a clavicle (collarbone) fracture is 400 mg every 4 to 6 hours as necessary for relief of pain 1.
From the Research
For pain management of a clavicle fracture, I recommend a stepwise approach starting with acetaminophen 650-1000 mg every 6 hours (not exceeding 4000 mg daily) combined with an NSAID such as ibuprofen 400-600 mg every 6 hours with food (maximum 3200 mg daily) for the first few days. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of multimodal pain management in reducing morbidity and improving quality of life for patients with clavicle fractures 2.
Key Considerations for Pain Management
- For moderate to severe pain, add tramadol 50-100 mg every 6 hours as needed for breakthrough pain, limiting opioid use to the first 3-5 days if possible.
- Ice the area for 20 minutes every 2-3 hours during the first 48-72 hours to reduce swelling and pain.
- Immobilization with a sling or figure-of-eight brace will also significantly reduce pain by limiting movement of the fracture site.
- As healing progresses (typically after 1-2 weeks), gradually reduce medication to acetaminophen alone as needed.
Rationale for Recommendations
The recommended approach is supported by the most recent evidence from the Cochrane review 2, which highlights the lack of high-quality evidence for specific conservative interventions but suggests that a multimodal approach to pain management can be effective in reducing pain and improving outcomes for patients with clavicle fractures.
Limitations and Future Directions
While the current evidence is limited, it emphasizes the need for further research into the most effective methods for conservative treatment of acute middle third clavicle fractures in adolescents and adults. However, based on the available evidence and clinical guidelines, the recommended stepwise approach to pain management can help minimize morbidity, mortality, and improve quality of life for patients with clavicle fractures.