Results of our search and description of studies
We searched different medical databases up to September 2014. We looked for studies that involved people with soft tissue injuries who had been assigned to either an oral NSAID or an alternative oral painkiller. We included 16 studies, with a total of 2144 participants. Seven of these studies included people with ankle sprain only. Two studies included children only. Most of the participants of the other studies were young adults, and there were slightly more males than females. The studies tested three comparisons: NSAIDs versus paracetamol (nine studies); NSAIDs versus opioids (four studies); NSAIDs versus the combination of paracetamol and an opioid (four studies). In many cases, the strength (dose) of one of the drugs being compared was less than recommended. Studies reported outcomes at times varying from one hour after taking medication up to 10 to 14 days.
Quality of the evidence
The evidence available for most outcomes was either low or very low quality. This means that we are unsure of the reliability of these results.
Results
We found no evidence for an important difference between NSAIDs and paracetamol for people with strains, sprains and bruises for pain relief, swelling or return to function at seven days or over. However, there was some evidence that people treated with NSAIDs had slightly more side-effects related to the stomach or intestines.
Although there was some evidence to suggest a greater return to function at seven days and fewer side-effects for people with sprains, strains and bruises using an NSAID compared with an opioid, we cannot say if this would apply to drugs that are currently available. This is because most of the evidence came from a study that tested an NSAID that is no longer on the market.
We found no evidence for an important difference between NSAIDs and a combination of paracetamol and opioid for people with sprains, strains and bruises regarding pain relief, swelling, return to function at seven days or over, or gut-related side-effects. However, the combination painkiller used in the studies is not now in common use. This means that we cannot be sure that these results would currently apply.
We found no studies comparing NSAIDs and complementary and alternative medicines. Also, no studies looked at the risk of re-injury after treatment.
Conclusions
This review found low or very low-quality but consistent evidence showing no important difference between NSAIDs and paracetamol, opioids or a combination of paracetamol and opioid in pain or swelling after a soft tissue injury. There is low-quality evidence of more gut-related complications with NSAIDs compared with paracetamol. Although there is either low- or very low-quality evidence of better function and fewer adverse events with NSAIDs compared with opioid-containing analgesics, one study dominated this evidence using a now unavailable NSAID and is therefore of uncertain applicability. Further research is required to determine whether there is any difference in return to function or adverse effects between different types of NSAIDs versus paracetamol.
Authors' conclusions:
There is generally low- or very low-quality but consistent evidence of no clinically important difference in analgesic efficacy between NSAIDs and other oral analgesics. There is low-quality evidence of more gastrointestinal adverse effects with non-selective NSAID compared with paracetamol. There is low- or very low-quality evidence of better function and fewer adverse events with NSAIDs compared with opioid-containing analgesics; however, one study dominated this evidence using a now unavailable COX-2 selective NSAID and is of uncertain applicability. Further research is required to determine whether there is any difference in return to function or adverse effects between both non-selective and COX-2 selective NSAIDs versus paracetamol.