From the Guidelines
If you've fallen and are experiencing shoulder pain but can't take NSAIDs or Tylenol, the most effective treatment approach is to use topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain, as recommended by the American College of Physicians and American Academy of Family Physicians 1. This approach is based on moderate-certainty evidence and is aimed at improving physical function and patient treatment satisfaction. Some key points to consider in managing your shoulder pain include:
- Applying ice to the affected area for 15-20 minutes every 2-3 hours during the first 48 hours to reduce inflammation and pain.
- Switching to heat therapy using a warm compress or heating pad for 15-20 minutes several times daily after the initial period to improve blood flow and promote healing.
- Resting the shoulder and avoiding movements that worsen the pain.
- Starting gentle range-of-motion exercises once the acute pain subsides.
- Considering alternative pain management approaches such as physical therapy, acupuncture, or prescription medications if the pain is severe or persists beyond a few days. It's also important to note that opioids, including tramadol, are not recommended for treating acute pain from non–low back, musculoskeletal injuries due to the risk of opioid use disorder and other adverse effects 1. If your pain persists or worsens, it's crucial to seek medical attention to rule out more serious injuries that may require professional evaluation and treatment.
From the Research
Alternatives to NSAIDs and Tylenol for Shoulder Pain
- Topical therapies, such as topical NSAIDs, capsaicin, and lidocaine, have been shown to be effective in managing chronic pain, including musculoskeletal pain, without the need for oral NSAIDs or Tylenol 2, 3, 4.
- Topical NSAIDs, in particular, have been found to provide relief superior to that of placebo and comparable to that of oral ibuprofen, with a lower incidence of gastrointestinal complaints 2, 4.
- Capsaicin and lidocaine have also been shown to be useful in the treatment of neuropathic pain, including postherpetic neuralgia and diabetic peripheral neuropathic pain 2, 3.
Considerations for Shoulder Pain After a Fall
- For acute musculoskeletal pain, such as shoulder pain after a fall, topical NSAIDs may be a suitable option, as they have been shown to be effective in treating acute musculoskeletal pain syndromes, including strains and sprains 3, 5.
- Topical lidocaine may also be considered for postherpetic neuralgia, although its efficacy for other types of pain, including shoulder pain, is less clear 3, 5.
- Other topical analgesics, such as capsaicin and salicylates, may be available, but their efficacy and safety profiles are less well-established 4.
Guidance for Choosing a Topical Analgesic
- The choice of topical analgesic should be guided by the type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost 5.
- Current evidence supports the use of topical NSAIDs for decreasing musculoskeletal pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time 5.