Ankle Sprain

Nonopioid Treatments Can Be More Effective

Ankle sprains are a very common musculoskeletal injury, with roughly half of all patients experiencing this injury seeking medical care.[1] Pain related to most ankle sprains can often lessen within 2 weeks,[1] and evidence shows that nonopioid treatments like acetaminophen or ibuprofen can be more effective than opioids in managing pain.[2]

Opioid Use for Ankle Sprains Can Carry Long-Term Risk

In 2017, however, 12.9% of privately insured patients with a musculoskeletal sprain/strain received an opioid prescription to treat their pain, with an average daily dosage of 32 MMEpdf icon for 6.7 days.[3]

A 2018 study of privately insured patients receiving care for an ankle sprain in the emergency department (ED) found that 25.1% received an opioid prescription, with a median total MME of 100 and an average days’ supply of 3. Patients in this study who received more than 225 MME had a higher rate of prolonged opioid use compared to patients receiving less than 75 MME highlighting that opioid for ankle sprains can carry long-term risk.[4]

13 percent graph

Almost 13% of insured patients with a sprain received an opioid prescription for their pain.

25 percent graph

Over 25% of insured patients who went to the Emergency Department for an ankle sprain, were given an opioid prescription.

Treatment Recommendations

“Routine opioid use for treatment of non-severe acute pain (e.g., low back pain, sprains, or minor injury without signs of tissue damage) [is not recommended].”

  • “Start with acetaminophen for mild to moderate pain. Acetaminophen may be dosed up to 4 grams for acute use, but <2-3 grams per day may be safer for prolonged use. Assess for all acetaminophen containing products to avoid inadvertent overdose. Use acetaminophen with caution and at doses of <2 grams daily in those at risk for hepatotoxicity, including those with advanced age and liver disease (e.g., alcohol abuse, hepatitis B and C).”
  • “Use non-steroidal anti-inflammatory drugs (NSAIDsexternal icon) for inflammatory, nociceptive pain. Monitor patients for potential renal, gastrointestinal (GI), and cardiac side effects. … Avoid NSAIDs in patients with a calculated glomerular filtration rate (cGFR) < 60 ml/min/1.73 m2.”

[1]van Rijn RM, van Os AG, Bernsen RM et al. What is the Clinical Course of Acute Ankle Sprains? A systematic literature review. Am J Med. 2008 Apr;121(4):324-331
[2]Chang AK, Bijur PE, Esses D et al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial. JAMA. 2017 Nov 7;318(17):1661-1667.
[3] Mikosz CA, Zhang K, Haegerich T, Xu L, Losby JL, Greenspan A, Baldwin G, Dowell D. Indication-Specific Opioid Prescribing for US Patients with Medicaid or Private Insuranceexternal icon, 2017. JAMA Network Open. 2020;3(5):e204514. doi:10.1001/jamanetworkopen.2020.4514
[4] Delgado MK, Huang Y, Meisel Z et al. National Variation in Opioid Prescribing and Risk of Prolonged Use for Opioid-Naive Patients Treated in the Emergency Department for Ankle Sprains. Ann Emerg Med. 2018 Oct;72(4):389-400