Therapy goals
- Reduction of pain and thus increase of mobility.
- Diagnosis finding
Therapy recommendations
- Analgesia (pain relief) during diagnosis until definitive therapy according to WHO staging scheme:
- Non-opioid analgesic (paracetamol, first-line agent) – see also “Further notes”.
- Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic.
- High-potency opioid analgesic (eg, morphine) + non-opioid analgesic.
- If necessary, anti-inflammatory drugs / drugs that inhibit inflammatory processes, eg NSAIDs (non-steroidal anti-inflammatory drugs) such as acetylsalicylic acid, ibuprofen, diclofenac.
- If necessary, also muscle relaxants (for stronger painful muscle tension).
- Outpatient calculated antibiotic therapy – only in septic events.
- See also under “Further therapy“.
Further notes
- For severe acute extremity pain (mean, 8.7; on a scale of 0-10 (most severe pain)) from the shoulder or hip down, ibuprofen–paracetamol combination decreased the pain scale score by an average of 4.3 points after two hours. Oxycodone and acetaminophen caused a reduction of 4.4 points.
- Tolperisone (muscle relaxants) is approved only for the treatment of poststroke spasticity in adults. Outside this approved indication, for example, there is a risk of hypersensitivity reactions (up to and including anaphylactic shock), with no proven benefit.
