Rethinking Post-Injury Pain Management: Are We Getting It Wrong?

Summer is a time of activity and movement for many people, but all of those pickup pickleball games and impromptu pool races also raise the risk of injury. If you do happen to pull a muscle or roll an ankle, what’s the best treatment?

While your first instinct might be to reach for an ice pack and over-the-counter painkiller, some medical professionals now suggest that people avoid anti-inflammatories during the early stages of a soft tissue injury.

The advice is part of broader guidance dubbed PEACE and LOVE, a newer but not universally-adopted approach some experts recommend for treating injuries like sprains and strains.

Here’s what you need to know about the proposed guidance, why there's a difference of opinion regarding using anti-inflammatories for soft tissue injuries, and what experts Health spoke to say you should do if you happen to get injured.

To understand the acronym PEACE and LOVE, you have to go back to the original guidance for treating soft tissue injuries.

For years, doctors recommended that people who sustain a soft tissue injury follow RICE, which stands for rest, ice, compress, and elevate. Eventually, the acronym evolved into PRICE, with the letter “P” standing for protecting the area from further injury.

More recently, some experts have turned to PEACE and LOVE as an alternative. Two Canadian researchers introduced the concept in an editorial published in the British Journal of Sports Medicine in 2020.

The second part—LOVE—refers to what to do after the first few days of an injury have passed. It stands for:

L: Load, which means putting more weight on the injured body part

O: Optimism, or staying positive about your recovery

V: Vascularization, a nod to increasing blood flow to the injury

E: Exercise to help restore range of motion and strength

PEACE, on the other hand, is the approach some experts advise that people follow immediately after an injury occurs. It’s similar to previous guidance in that it calls for protecting, elevating, and compressing the injury. But there are two differences.

One is the inclusion of the second “E,” which stands for “education.” It means that medical professionals should teach their patients to help their injuries heal naturally rather than rely on treatments such as acupuncture or electrotherapy. The other difference, which is more controversial, suggests that people should “avoid anti-inflammatories” such as icing and nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen.

To make sense of why some experts recommend skipping icing and NSAIDs after an injury, it helps to understand how the body heals.

During a soft tissue injury's acute or early phase, the body attempts to repair itself through inflammation.

“Historically, inflammation was thought of as being a bad thing,” Clint Soppe, MD, an orthopedic surgeon and sports medicine specialist at the Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, told Health. “But we’ve learned that inflammation is a normal process for healing with acute injuries. We need this inflammatory mechanism and reaction to heal.”

That’s because inflammation helps your body clear damaged and dead tissue and harmful organisms like bacteria, Ashley Rawlins, PT, DPT, a physical therapist and clinical specialist at Origin, told Health.

In theory, taking NSAIDs right after sustaining an injury could prevent inflammation from happening at all in your soft tissue injury, she explained. As a result, some experts are worried that tamping down on inflammation with ice and NSAIDs right after an injury will slow the healing of damaged tissue and delay your recovery, Lauren Porras, MD, clinical associate professor of orthopedics at Vanderbilt University Medical Center, told Health.

Craig Wassinger, PhD, a professor in the Department of Rehabilitation Science at Tufts University School of Medicine, told the school’s newspaper in May that “inflammation, even though it’s painful, is helpful for our body tissues to recover.” As a result, anti-inflammatories “should not necessarily be used right away,” he said.

While some experts agree that icing and NSAIDs should be avoided right after an injury, many do not.

The negative effect that anti-inflammatories might have on healing “has mostly been studied in animal models and has not been robustly studied in humans,” Porras said. “PEACE and LOVE should be more robustly studied in humans before we adopt these recommendations universally.”

Soppe agreed. “We don’t have an exact answer on if we should avoid them altogether or if they’re okay to take for a certain period of time,” he said.

There is evidence that suggests regular use of NSAIDs can slow bone healing after injuries like fractures, but that’s not the same as a soft tissue injury.

Given the lack of scientific clarity, Porras said she “would be fine” with a patient using ice and anti-inflammatories if they are having significant pain and these methods seem to improve it. “Ice and anti-inflammatories have been shown to improve pain and swelling and should still be considered as a resource for symptomatic relief,” she added.

While Soppe said acetaminophen, or Tylenol, may be helpful after a soft tissue injury, he thinks NSAIDs are better. “In my experience, anti-inflammatories are much more helpful in pain control compared to acetaminophen,” he said.

If your injury is minor, the experts said it should be fine to ride it out with the PRICE method and NSAIDs if they seem to help. But if you’re still struggling after a few days, it’s time to consult a professional.

“Not all soft tissue injuries mean you need to see a medical professional, particularly if your pain is mild or eases with rest,” Rawlins said. “However, if your pain is more severe, caused by a significant accident, you cannot put weight on it, or it sticks around despite you trying to rest and manage your symptoms on your own, then it is a good idea to check in with a healthcare provider.”