Priority 5 from the Broken Bones of the Upper Limb in People over 50

UNCERTAINTY: What is the best alternative to medication / drugs to manage pain following an upper limb fracture in people over 50? (e.g. splints / casts / lining the fracture back up / ice)? (JLA PSP Priority 5)
Overall ranking	5
JLA question ID	0093/5
Explanatory note	Sustaining an upper limb fracture and its subsequent management can be a very painful experience. We normally use medications to help control this pain but there are other ways that we can control pain at different stages of a patient's treatment. This question looks to determine what the best ways are to reduce acute and chronic pain that does not involve medication. Uncertainties included questions about casting; using slings; and immobilisation of the fracture.
Evidence	Johnson MI, Paley CA, Howe TE, Sluka KA; Transcutaneous electrical nerve stimulation for acute pain. Cochrane Database of Systematic Reviews 2015, Issue 6. Green S, Buchbinder R, Hetrick SE; Acupuncture for shoulder pain. Cochrane Database of Systematic Reviews 2005, Issue 2
Health Research Classification System category	Injuries and Accidents

Extra information provided by this PSP
Original uncertainty examples	I cannot take most painkillers or anti inflammatories. What other ways are there of reducing pain? ~ Prediction of outcome helps the patient to understand their pain and manage it better, so is early advice possible? ~ I cannot take most painkillers or anti inflammatories. What other ways are there of reducing pain? ~ What non-pharmacological analgesia is best for prehospital treatment (immobilisation/reduction/ice/support)?
Submitted by	5 x Healthcare Professionals, 12 x Patients

Extra information provided by this PSP

Original uncertainty examples

I cannot take most painkillers or anti inflammatories. What other ways are there of reducing pain? ~ Prediction of outcome helps the patient to understand their pain and manage it better, so is early advice possible? ~ I cannot take most painkillers or anti inflammatories. What other ways are there of reducing pain? ~ What non-pharmacological analgesia is best for prehospital treatment (immobilisation/reduction/ice/support)?

Submitted by

5 x Healthcare Professionals, 12 x Patients

PSP information
PSP unique ID	0093
PSP name	Broken Bones of the Upper Limb in People over 50 PSP
Total number of uncertainties identified by this PSP.	50 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	3 December 2018