Use of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) and Opioids in the Treatment of Musculoskeletal Injuries in Athletes and Physical Activity Practitioners: Evidence and Risks Medications in Clinical Orthopedics

Thirty-nine published studies, including clinical trials, cohort studies, and reviews, were evaluated. NSAIDs have demonstrated consistent efficacy in relieving acute pain and reducing inflammation in injuries such as sprains and strains, especially in short courses. However, their ability to accelerate healing or improve long-term outcomes has not been proven, with some evidence suggesting a potential delay in tissue repair, such as in stress fractures. The risks associated with NSAIDs are significant and well documented, including gastrointestinal and cardiovascular problems and nephrotoxicity, the latter being particularly relevant for athletes due to factors such as dehydration. Self-medication with NSAIDs, common among athletes, further increases these risks, reinforcing the need for judicious and monitored use. For opioids, evidence of efficacy in non-oncological musculoskeletal injuries in athletes is limited, restricted to cases of severe and refractory pain, such as in the immediate postoperative period. The main warning lies in the substantial risks, especially the potential for dependence and misuse, even after short periods of prescription. Adverse effects, such as sedation and constipation, can seriously compromise rehabilitation and delay return to sports activities. In conclusion, clinical orthopedics should adopt a rational and multifaceted therapeutic approach. NSAIDs may be useful in the acute phase of pain, but their use should be brief, at the lowest effective dose, and always with individual and h y risk assessment. The use of opioids should be extremely restricted, considering them only as a last resort and under strict surveillance due to the inherent risks. The prioritization of non-pharmacological therapies, such as physical therapy and therapeutic exercise, is essential to promote functional and sustainable recovery, ensuring a safe and healthy return of athletes to sports.