Non-steroidal anti-inflammatory drugs (NSAIDs) for treating acute ankle sprains in adults: benefits outweigh adverse events.
OBJECTIVE
In the recent clinical guideline for acute lateral ankle sprain, the current best evidence for diagnosis, treatment and prevention strategies was evaluated. Key findings for treatment included the use of ice and compression in the initial phase of treatment, in combination with rest and elevation. A short period of taking non-steroidal anti-inflammatory drugs (NSAIDs) may facilitate a rapid decrease in pain and swelling can also be helpful in the acute phase. The objective was to assess the effectiveness and safety of oral and topical NSAID in the treatment for acute ankle sprains.


METHODS
Randomised controlled trials comparing oral or topic NSAID treatment with placebo or each other were included. Primary outcome measures were pain at rest or at mobilisation and adverse events. Trials were assessed using the Cochrane risk of bias tool.


RESULTS
Twenty-eight studies were included, and 22 were available for meta-analysis. Superior results were reported for oral NSAIDs when compared with placebo, concerning pain on weight bearing on short term, pain at rest on the short term, and less swelling on short- and intermediate term. For topical NSAIDs, superior results compared with placebo were found for pain at rest (short term), persistent pain (intermediate term), pain on weight bearing (short- and intermediate term) and for swelling (short and intermediate term). No trials were included comparing oral with topic NSAIDs, so conclusions regarding this comparison are not realistic.


CONCLUSIONS
The current evidence is limited due to the low number of studies, lack of methodological quality of the included studies as well as the small sample size of the included studies. Nevertheless, the findings from this review support the use of NSAIDs for the initial treatment for acute ankle sprains.


METHODS
Meta-analysis of RCTs, Level I.
OLVG, Amsterdam, The Netherlands. Bekerom@gmail.com.
Michel P J
MPJ
van den Bekerom
MCA, Alkmaar, The Netherlands.
Arnout
A
Sjer
Amphia hospital, Breda, The Netherlands.
Matthijs P
MP
Somford
OLVG, Amsterdam, The Netherlands.
Gythe H
GH
Bulstra
AMC, Amsterdam, The Netherlands.
Peter A A
PAA
Struijs
AMC, Amsterdam, The Netherlands.
Gino M M J
GMMJ
Kerkhoffs
D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D016512:Ankle Injuries / Q000188:drug therapy*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018771:Arthralgia / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013180:Sprains and Strains / Q000188:drug therapy*
D000894:Anti-Inflammatory Agents, Non-Steroidal