Page 297 Acute Pain Management

The relevant key messages of these guidelines are very similar to the ones presented here.

Key messages
1. Acute low back pain is non‐specific in about 95% of cases and serious causes are rare;
common examination and investigation findings also occur in asymptomatic controls and
may not be the cause of pain (U) (Level I).
2. Advice to stay active, ‘activity‐focused’ printed and verbal information, and behavioural
therapy interventions are beneficial in acute low back pain (U) (Level I).
3. Advice to stay active, exercises, multimodal therapy and pulsed electromagnetic therapy
(in the short term) are effective in acute neck pain (U) (Level I).
4. Soft collars are not effective for acute neck pain (U) (Level I).
5. Appropriate investigations are indicated in cases of acute low back pain when alerting
features (‘red flags’) of serious conditions are present (U) (Level III‐2).

6. Psychosocial and occupational factors (‘yellow flags’) appear to be associated with
progression from acute to chronic back pain; such factors should be assessed early to
facilitate intervention (U) (Level III‐2).

9.5 ACUTE MUSCULOSKELETAL PAIN

Other than acute back pain, acute shoulder and anterior knee pain are two common painful
musculoskeletal conditions.
A summary of findings relating to acute musculoskeletal pain can be found in Evidence‐based
Management of Acute Musculoskeletal Pain, published by the Australian Acute
Musculoskeletal Pain Guidelines Group and endorsed by the NHMRC (Australian Acute
Musculoskeletal Pain Guidelines Group, 2003). In view of the high quality and extensiveness of
these guidelines, no further assessment of these topics has been undertaken for this
document.
The following is an abbreviated summary of key messages from these guidelines and represent
the consensus of the Steering Committee of these guidelines.
These guidelines can be found on the NHMRC website (Australian Acute Musculoskeletal Pain CHAPTER 9
Guidelines Group, 2003).

Key messages
1. Topical and oral NSAIDs improve acute shoulder pain (U) (Level I).
2. Subacromial corticosteroid injection relieves acute shoulder pain in the early stages (U)
(Level I).
3. Exercises improve acute shoulder pain in patients with rotator cuff disease (U) (Level I).
4. Therapeutic ultrasound may improve acute shoulder pain in calcific tendonitis (U) (Level I).
5. Advice to stay active, exercises, injection therapy and foot orthoses are effective in acute
patellofemoral pain (U) (Level I).
6. Low‐level laser therapy is ineffective in the management of patellofemoral pain (U)
(Level I).

Acute pain management: scientific evidence 249