Can Disperzyme (digestive enzyme) be used to treat pain from an acute muscle sprain?

Disperzyme Should Not Be Used for Acute Muscle Sprain Pain

Disperzyme (a digestive enzyme supplement) has no role in treating pain from acute muscle sprains and should not be used for this indication. Digestive enzymes are designed to break down proteins, carbohydrates, and lipids in the gastrointestinal tract for conditions like pancreatic insufficiency and lactose intolerance—not for musculoskeletal pain 1, 2.

Evidence-Based Treatment for Acute Muscle Sprain Pain

First-Line Pharmacologic Treatment

Topical NSAIDs provide the greatest benefit-harm ratio for acute musculoskeletal injuries including sprains, followed by oral NSAIDs or acetaminophen 3.

• Topical NSAIDs with or without menthol gel are recommended as first-line therapy for acute musculoskeletal injuries, offering effective pain relief with minimal systemic side effects 3
• Oral NSAIDs are more effective than opioids for musculoskeletal pain and should be used if topical agents are insufficient 3
• Acetaminophen (up to 4g/day) is the preferred oral analgesic when NSAIDs are contraindicated, though it is less effective than NSAIDs 3

Non-Pharmacologic Interventions

Ice and elevation should be applied immediately to reduce swelling and discomfort from musculoskeletal injuries 3.

• Heat therapy, massage, and acupressure may provide additional benefit for acute musculoskeletal pain 3
• Physical therapy should be initiated as pain and swelling subside to restore flexibility and strength 4

Muscle Relaxants: Use With Caution

If NSAIDs and non-pharmacologic measures are insufficient, skeletal muscle relaxants may provide short-term pain relief (2-4 days) but should never be continued beyond 2-3 weeks 3, 5.

• Tizanidine is the preferred muscle relaxant alternative with the strongest evidence base, though it carries cardiovascular risks including hypotension and bradycardia that require monitoring 6, 7
• All muscle relaxants increase adverse events by 50% and double CNS adverse events (sedation, dizziness) compared to placebo 3, 7
• The term "muscle relaxant" is misleading—these drugs work through sedative properties, not direct muscle relaxation 6

Combination Therapy Strategy

Adding a muscle relaxant to an NSAID or acetaminophen provides greater short-term pain relief than analgesic monotherapy 6.

• This combination increases CNS adverse events but may reduce gastrointestinal adverse events 6
• Reserve combination therapy for severe pain unresponsive to NSAIDs alone

Medications to Avoid

Opioids provide no better benefit than NSAIDs for musculoskeletal injuries and cause significantly more harms 3.

• Opioids are associated with increased risk of nausea, dizziness, somnolence, and long-term opioid use 3
• Corticosteroids have been shown to adversely affect healing of acute muscle injuries 8

Critical Clinical Pitfalls

• Never use digestive enzymes like Disperzyme for musculoskeletal pain—they have no mechanism of action for this indication 9, 1, 2
• Avoid prolonged NSAID use in patients with cardiovascular disease, hypertension, renal insufficiency, heart failure, or peptic ulcer disease risk 3
• Do not continue muscle relaxants beyond 2-3 weeks as all clinical trials were ≤2 weeks duration and prolonged use increases CNS adverse events without additional benefit 3, 5, 7
• Avoid benzodiazepines due to abuse potential and increased fall risk, especially in older adults 6

Treatment Algorithm for Acute Muscle Sprain

1. Immediate care: Apply ice and elevation to reduce swelling 3
2. First-line pharmacologic: Start topical NSAIDs with or without menthol gel 3
3. If inadequate response: Add oral NSAIDs (if no contraindications) or use acetaminophen 3
4. If still inadequate: Consider adding tizanidine (start 2-4mg, titrate as needed) for maximum 2-3 weeks 6, 7
5. Concurrent therapy: Initiate physical therapy as pain subsides to restore function 4
6. Long-term outcome: Most muscle strains have excellent outcomes with few complications when treated appropriately 4