TRAUMEEL® PRODUCT MONOGRAPH10

there is a paucity of research evidence concerning acute musculoskeletal injury. Much of common practice is based on historical precedent rather than randomized controlled trials.[MacAuley 2002] Indeed, it has been observed that even the most accepted treatments find little support when critically evaluated.

Clinical practice guidelines for pain management in acute musculoskeletal injury developed by the Orthopaedic Trauma Association presented evidence-based best practice recommendations and pain medication recommendations. The authors concluded that balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies.[Hsu 2019]

RICE Rest, ice, compression, elevation (RICE) is a mnemonic used to guide the early treatment after acute musculoskeletal injury.[MacAuley 2002] However, the evidence base for this intervention is lacking and guidance on how to apply ice and/or compression varies between sources. Thus, although widely accepted, there is little evidence for the effectiveness of this intervention, and even suggestion that it may be detrimental to recovery.[van den Bekerom 2012]

Non-steroidal anti-inflammatory drugs Non-steroidal anti-inflammatory drugs (NSAIDs) have both anti-inflammatory and analgesic properties. Although therapeutic inhibition of COX-2 by NSAIDs may have beneficial effects in the early phase of inflammation by preventing prostanoid production, it may also be resolution-toxic, by disrupting the production of anti- inflammatory prostaglandins and lipid mediators, such as LXs (e.g., lipoxin A4 and lipoxin B2).[Sugimoto 2016] In the gastrointestinal (GI) tract, they also inhibit COX-1 activity, decrease prostaglandins, and increase the risk of GI side effects such as life- threatening bleeding and ulceration.[Sullivan 2007] The COX-2 specific agents (celecoxib) and COX-2 selective agents (etodolac, meloxicam) have a decreased risk of clinically significant GI side effects compared with other NSAIDs, but increased costs and potential cardiovascular risks limit their use.

NSAIDs are commonly used in the treatment of acute soft tissue injuries, yet there is a lack of evidence for long-term benefit and concern over side effects.[Jones 2016, Bisciotti 2018, Vuurberg 2018] Indeed, there are suggestions that the short-term benefits of NSAIDs may be outweighed by long-term compromise of the structure and function of the injured tissue.[Vuurberg 2018] NSAID use can and does alter certain fundamental processes involved in the normal healing of injured tissues.[O Connor 2008] Importantly, their use could hinder progression to the proresolution phase of inflammation.[Sugimoto 2016, Loynes 2018]

The use of NSAIDs in treating muscle injury is controversial.[Paoloni 2009] Indeed, the use of NSAIDs is actively discouraged in the treatment of muscle tears.[Fernandez-Jaén 2016] Conditions in which NSAID use requires more careful assessment include ligament injury, joint injury, osteoarthritis, haematoma and postoperatively.[Paoloni 2009]