Management of Acute Muscle Sprains

Introduction to Evidence-Based Treatments

The American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) recommend oral NSAIDs as first-line pharmacologic treatment to reduce pain and improve physical function in patients with acute muscle sprains, with moderate-certainty evidence 1
The ACP and AAFP also recommend oral acetaminophen as an alternative to reduce pain in patients with acute muscle sprains, with moderate-certainty evidence 1

Specific acupressure or TENS can be considered as nonpharmacologic options for pain reduction in patients with acute muscle sprains, with low-certainty evidence 1

The American College of Physicians and American Academy of Family Physicians guideline recommends against using opioids, including tramadol, for acute muscle sprains, with a conditional recommendation 1
Oral NSAIDs, such as ibuprofen or naproxen, can reduce pain by approximately 0.93 cm on a 10-cm visual analog scale at <2 hours in patients with acute muscle sprains, with moderate-certainty evidence 3, 4
Acetaminophen can reduce pain by approximately 1.03 cm on a 10-cm scale at <2 hours in patients with acute muscle sprains, with moderate-certainty evidence 3, 4

The American Geriatrics Society states that muscle relaxants, as a class, are potentially inappropriate medications due to anticholinergic effects, sedation, and increased fall risk, with specific reference to the use of baclofen as a preferred agent over other muscle relaxants 5
Eperisone is not recommended for use in elderly patients; if muscle relaxants are needed, baclofen is the preferred agent, with reference to guidelines from the American Geriatrics Society 5, 7