Arnica and the Management of Pain in Acute Musculoskeletal Extremity Injuries

Inclusion Criteria: * Patient presents to the Emergency Department with an acute, soft tissue ankle or forearm injury * ED Provider orders an X-ray for evaluation of injury * Patient's initial pain score is of a 4 or higher * Patient has noticeable swelling at the site of the injury Exclusion Criteria: * Patient is diagnosed with a fracture * Patient has an allergy to ibuprofen * Patient is already on a NSAID, acetaminophen, anticoagulant or oral corticosteroid therapy for chronic pain treatment (a NSAID given in triage or use for the current injury is allowed) * Use of other concurrent complementary medicine therapy, e.g. massage, acupuncture, physical therapy * Patient has been treated for this injury in the past * Patient has a bleeding/bruising disorder * Patient is pregnant or is lactating * Patient has a liver or kidney disease, malignancy, infection, immunodeficiency or metabolic syndrome * Patient is allergic to the Asteraceae family of plants (arnica, ragweed, chrysanthemum, marigold, or daisy are the most common) * Patient is nonverbal, and thus unable to give a pain score * Patient does not have a working telephone (required for follow-up call) * Family requires foreign language interpreter during their ED visit