What can I take for nerve pain from a healing ankle sprain?

Pain Management for Nerve Pain from Healing Ankle Sprain

For nerve pain from a healing ankle sprain, start with topical NSAIDs (diclofenac gel) as first-line therapy, combined with oral NSAIDs (ibuprofen 400mg three times daily or naproxen) for short-term use (<14 days), while avoiding opioids entirely due to their significantly higher side effect profile without superior pain relief. 1, 2

First-Line Pharmacological Approach

Topical NSAIDs should be your primary choice:

• Apply topical diclofenac gel to the affected area, which provides superior pain relief compared to placebo (OR 6.39) with fewer systemic side effects than oral NSAIDs 2
• Topical NSAIDs have markedly fewer gastrointestinal adverse events while maintaining equivalent pain relief to oral formulations 2
• Local skin reactions are the most common side effects but occur at similar rates to placebo 2

Add oral NSAIDs for additional pain control if needed:

• Ibuprofen 400mg three times daily, naproxen, diclofenac, or celecoxib are all effective options for reducing pain and swelling in the short term (<14 days) 3, 1
• Diclofenac shows superior results at days 1 and 2 compared to other NSAIDs for reducing pain during motion 3, 2
• Celecoxib 200mg twice daily is non-inferior to non-selective NSAIDs with similar adverse event rates 3, 2

Alternative if NSAIDs Are Contraindicated

Acetaminophen (paracetamol) is equally effective as NSAIDs:

• Use acetaminophen 500mg three times daily or extended-release 1,300mg three times daily 3, 4
• Acetaminophen appears equally effective as NSAIDs for pain, swelling, and range of motion in ankle sprains 3, 2, 4
• This is particularly valuable if you have gastrointestinal issues, kidney problems, or other contraindications to NSAIDs 1, 2

Critical Medications to Avoid

Do not use opioid analgesics:

• Opioids (tramadol/acetaminophen, hydrocodone/acetaminophen) provide similar pain relief as NSAIDs but lead to significantly more side effects 3, 2, 5
• Common adverse events include somnolence, nausea, dizziness, and vomiting 5
• The risk-benefit ratio strongly favors NSAIDs or acetaminophen over opioids 3, 1

Important Considerations About Nerve Pain

True nerve injury after ankle sprain is rare but possible:

• Peroneal nerve palsy can occur simultaneously with ankle sprains, though the exact incidence is not well established 6
• Delayed peroneal nerve palsy is possible even if initial neurological status was normal 6
• If you experience persistent numbness, tingling, weakness in foot dorsiflexion, or inability to lift your foot, seek immediate medical evaluation as this may indicate nerve entrapment requiring different management 6, 7

Duration and Safety Considerations

Limit NSAID use to short-term therapy:

• Use NSAIDs for less than 14 days to minimize potential adverse effects 1, 2
• NSAIDs may theoretically delay natural healing by suppressing inflammation necessary for tissue recovery, though clinical significance remains unclear 3, 2
• Monitor for gastrointestinal symptoms (nausea, abdominal pain, black stools), and discontinue if these occur 8

Comprehensive Management Beyond Medication

Combine pain medication with functional rehabilitation:

• Begin supervised exercise therapy within 48-72 hours after injury, which has Level 1 evidence for effectiveness 1, 9
• Use a lace-up or semi-rigid ankle brace for 4-6 weeks 1, 9
• Apply cold therapy (ice and water mixture surrounded by damp cloth) for 20-30 minutes, 3-4 times daily for the first 48-72 hours 1, 2

Common Pitfalls to Avoid

• Do not use heat application for acute ankle injuries 1
• Do not rely on RICE protocol alone without exercise therapy, as it has no evidence for effectiveness when used in isolation 1
• Do not continue NSAIDs beyond 14 days without medical supervision 1, 2
• Do not ignore persistent neurological symptoms (numbness, weakness, foot drop) as these may indicate nerve injury requiring specialized evaluation 6