Australian Doctor Australian Doctor 2 June 2017 | Page 27

Topical NSAIDs are increasingly being used due to their minimisation of systemic effects . It has been found that plasma concentrations after topical administration are as low as 5 % of the plasma levels of oral NSAIDs , resulting in a greatly reduced side-effect profile , and should therefore be recommended . 25

Oral opioids should rarely be used , unless for severe pain , due to their potential gastrointestinal and neurological side effects , and addictive properties . 23

A recent meta-analysis found a lack of difference in analgesic efficacy between NSAIDs and paracetamol or NSAIDs and opioids for acute soft tissue injuries . 23

However , NSAIDs were associated with increased gastrointestinal side effects relative to paracetamol , but with fewer adverse events and better functioning than opioid-containing medications

23 , 24

.

Return to exercise Due to the wide range of muscular injuries , no ‘ one size fits all ’ approach exists . Once a musculoskeletal injury has occurred , the main goals should be to return to exercise in a timely fashion , and minimise the risks of re-injury by completing rehabilitation in a step-wise fashion . 11

Returning to exercise should be guided by the severity of the injury , the healing process , patient and activity factors , and ideally , by a practitioner experienced in rehabilitation .

Universally , each patient must be allowed adequate time for the inflammatory and reparative phases to occur . Therefore it is important that practitioners deliver sound advice and education during this time to reduce injury , and maximise functional outcome . During the maturation / remodelling phase , the patient should be progressed through a stepwise rehabilitation program that incorporates multiple stages , as shown in figure 2 .

Initially , the patient should build up to pre-injury range of motion with exercises to maintain muscular power and proprioception .

Once this has been achieved without pain , it is often tempting for the patient to return to pre-injury exercise , but this is not recommended . At this stage , the patient should resume controlled activity including whole-body exercise , building up to specific return-toactivity requirements such as increased speed , agility , and sports-specific fitness and skills .

Once the patient has reached sustained activityspecific exercise in a practice or training environment , their return to exercise should then be considered .

Sports clinicians ( for example , sports physicians , exercise physiologists , and physiotherapists ) are welltrained to deliver personalised advice on appropriate interventions , exercises , and guided return-to-exercise . ● Dr Wheeler is a medical officer at SA Health . Dr Tomkinson ( PhD ) is an associate professor in kinesiology and public health education at the University of North Dakota , US , and an adjunct professor at the University of SA .

References on request .

Figure 2 . A stepped approach to returning to exercise .

NEW ACZONE ® dapsone 7.5 % w / w topical gel

· Once-daily dosing 1

· Proven efficacy and tolerability at week 12 1 , 2

· Studied in large pivotal trials used for the approval of a topical acne drug 1 , 2

2 . Restoration of range of motion

1 . Inflammatory and reparative phase

PBS Information : ACZONE ® is not listed on the PBS .

BEFORE PRESCRIBING , PLEASE REVIEW APPROVED PRODUCT INFORMATION AVAILABLE ON REQUEST FROM ALLERGAN BY PHONING 1800 252 224 OR FROM www . allergan . com . au / products

Australian Minimum Product Information . ACZONE ® topical gel is a prescription medicine containing 75 mg / g ( 7.5 % w / w ) of dapsone . Indications : For the topical treatment of acne vulgaris in patients 12 years of age and older . Contraindications : Hypersensitivity to ingredients ; individuals with congenital or idiopathic methaemoglobinaemia . Precautions : Only apply to affected areas and unbroken skin . For external use only . Avoid contact with eyes , eyelids and mouth . If contact with eyes occurs , rinse thoroughly with water . Use with caution in patients - with G6PD deficiency ; on oral dapsone or antimalarial medications ; on trimethoprim / sulfamethoxazole ( TMP / SMX ); lactating ; below 12 years and over 65 years ; on medications which may induce methaemoglobinaemia or on topical antibiotics or topical retinoids . Use in pregnancy is not recommended . Interactions : Trimethoprim / sulfamethoxazole ( TMP / SMX ) co-administration may cause increases levels of dapsone and its metabolites . Topical application of ACZONE ® 7.5 % w / w gel followed by benzoyl peroxide in patients with acne vulgaris may result in a temporary local yellow or orange discolouration of the skin and facial hair . Concomitant use of ACZONE ® 7.5 % w / w gel with drugs that induce methaemoglobinaemia may increase the risk for developing this condition . Adverse Reactions ( AE ): ≥1.0 %: dry skin , pruritus , pain . Dosage / Method of Use : For dermatological ( topical ) use only . After the skin is gently washed and patted dry , approximately a pea-sized amount of ACZONE ® 7.5 % w / w gel , should be applied in a thin layer to the entire face once daily . In addition , a thin layer may be applied to other affected areas once daily . ACZONE ® 7.5 % w / w gel should be rubbed in gently and completely . Patients should be instructed to wash their hands after application . Date of first inclusion in the ARTG : 10 January 2017

References : 1 . ACZONE ® Gel 7.5 % Approved Product Information . 2 . Thiboutot DM et al . Efficacy , Safety , and Dermal Tolerability of Dapsone Gel , 7.5 % in Patients with Moderate Acne Vulgaris : A Pooled Analysis of Two Phase 3 Trials . J Clin Aesthet Dermatol 2016 ; 9 ( 10 ): 18 – 27 .

™ ® Trademark ( s ) and registered trademark ( s ) of Allergan , Inc . Allergan Australia Pty Ltd 810 Pacific Highway , Gordon NSW 2072 . ABN 85 000 612 831 . © 2017 Allergan . All rights reserved . AU / 0391 / 2016 Date of preparation : February 2017 .

6 . Sport-specific activities

4 . Restoration of general fitness 3 . Restoration of muscle power

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