Analgesia in soft-tissue injury: current practice in Auckland is not supported by the available evidence

To document current prescribing habits and attitudes of doctors in the Auckland region towards analgesic medication for soft-tissue injury and determine whether the available evidence supports this practice.

A survey of 573 doctors in the Auckland region was conducted. There was a 71.4% response rate. The clinical and experimental evidence concerning non-steroidal, anti-inflammatory (NSAID) use in soft-tissue injury was reviewed. The side-effect profiles of NSAIDs were reviewed, with emphasis on the incidence of gastrointestinal side-effects when NSAIDs are prescribed for short periods and evidence implicating adverse renal effects on healthy exercising adults.

Most doctors ranked NSAIDs more effective than paracetamol (70.4%, p<0.01). NSAIDs were the most prescribed single analgesic agents (47.8%, p<0.0001). Diclofenac was the NSAID of choice for 69.8% of doctors, who used NSAIDs (p<0.001). The incidence of gastrointestinal side-effects for short-term use of NSAIDs in acute soft tissue was 11%.

The available evidence does not support the belief by the doctors surveyed that NSAIDs are more effective than paracetamol in soft-tissue injury. NSAIDs delay, but do not prevent the inflammatory response in injured tissue and may expose athletes to an increased risk of re-injury by delaying healing. Significant adverse effects do occur in previously healthy patients who receive NSAIDs.