Ankle Sprain

ankle pain
Nonopioid Treatments Can Be More Effective in Treating Ankle Sprains

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 3-days’ supply. 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]

Prescription Frequency

13 percent

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

Too Many Pills, Too Many Times

25 percent

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

Summary of Treatment Recommendations

American College of Occupational and Environmental Medicine

Opioids for Treatment of Acute, Subacute, Chronic, and Postoperative Painexternal icon (2017)

“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].”

Washington State Agency Medical Directors’ Group
  • Interagency Guideline on Prescribing Opioids for Painpdf iconexternal icon (2015)
  • “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 external iconInsuranceexternal 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