Musculoskeletal Pain Management

Anatomy or structure of the musculoskeletal systemThe musculoskeletal system is comprised of the skeleton and the muscles that are attached to it.1 In addition, it also consists of other tissue namely:2

• tendons• ligaments• joints(unionof2ormorebones)• cartilage

Three types of muscle are found in the body and include:2

• Skeletal •Thesemusclesareattachedtotheskeleton and contract voluntarily3

• Smooth •Smoothmusclecontracts involuntarily. eg: digestive system, blood vessels, bladder airways and female uterus3

• Cardiacmuscle •Thistypeofmuscleisonlyfoundintheheart3

skeletal:

smooth:

cardiac:

Function of the musculoskeletal system2

• form• stability• movementtothehumanbody

Muscles

What is musculoskeletal pain?4

Musculoskeletal pain affects the:

• bones• muscles• ligaments• tendons• nerves

Musculoskeletal pain can be:

• acute or chronic

• localised or widespread

Causesofmusculoskeletalpain

Types of musculoskeletal pain

Muscle pain is most frequently related to:• tension• overuse• muscleinjuryfromexerciseorphysicallydemandingworkThepaintendstoinvolvespecificmusclesandstartsduringorjustaftertheactivity.5

Tendonandligamentpain4

Paininthetendonsorligamentsareoftencausedbyinjuriessuchassprains.

The most common cause is injury to the soft tissues including muscles, tendons and ligaments found in these areas.

Pain can lead to a stiff neck or shoulder and a loss of range of motion. Headache may also result.

Often,nospecificcauseforthepaincanbefound.Mostlowerbackpain,however, generally follows injury or trauma to the back.7

Whatistensionheadache?8

Tension headaches are one of the most common form of headaches and occur when the neck and scalp muscles become tense or contract.

Injury4

Overuse4,5

Poorpostureorprolongedimmobilisation4 Tension or stress5

Muscle pain4,5

Neckandshoulderpain6

Lowerbackpain

Goals of treatment9

• Managepain

• Restoremobility

• Hastenrecoverysothatthepatientcanresumenormalactivitiesassoonaspossible

Centrallyactingskeletalmuscle relaxants

Non-opioidanalgesics Non-steroidalanti-inflammatorydrugs

(NSAIDs)

Opioidanalgesics

e.g. orphenadrine (Norflex®/Norflex® Co)

These agents may be combined with an analgesic

e.g. paracetamol

• These painkillers are recommended for the relief of mild to moderate acute musculoskeletal pain

• Can be used with opioids to manage more severe pain

e.g. ibuprofen e.g. codeine• An opioid analgesic may be necessary to relieve more severe musculoskeletal pain

Pain managementVarious types of drugs can be used to relieve pain associated with musculoskeletal pain and include:10

References: 1. Peters M. British Medical Association A-Z Family Medical Encyclopedia 5th ed. London(UK):Dorling Kindersley;2008; p. 525, 710, 715, 734. 2. Mooar P, reviewer. Biology of the Musculoskeletal System. Merck Manual Home Edition [Online] Available from URL: http://www.merckmanuals.com/home/sec05/ch058/ch058.html (Accessed 13.05.2011). 3. Freudenrich C. How Muscles Work Discovery Health [Online] Available from URL: http://health.howstuffworks.com/human-body/systems/musculoskeletal/muscle.htm (Accessed 13.05.2011). 4. Musculoskeletal Pain Cleveland Clinic [Online] Available from URL: http://my.clevelandclinic.org/disorders/musculoskeletal_pain/hic_musculoskeletal_pain.aspx (Accessed 13.05.2011). 5. Vorvick LJ, et al. Muscle aches: MedlinePlus Medical Encyclopedia [Online] Available from URL: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm (Accessed 13.05.2011). 6. Shiel WC. Shoulder and Neck Pain. eMedicinehealth.com [Online] Available from URL: http://www.emedicinehealth.com/script/main/art.asp?articlekey=59261&pf=3&page=1 (Accessed 13.05.2011). 7. Low Back Pain Fact Sheet: National Institute of Neurological disorders and Stroke (NINDS) Available from URL:http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm (Accessed 13.05.2011). 8. Sheth K. Tension headache: MedlinePlus Medical Encyclopedia [Online] Available form URL: http://www.nlm.nih.gov/medlineplus/ency/article/000797.htm (Accessed 13.05.2011). 9. Bhangle SD, et al. Back pain made simple: an approach based on principles and evidence. Cleve Clin J Med 2009;76(7): 393-99. 10. Truter I. Musculoskeletal pain. SA Pharm J Jan/Feb 2008;75(1):10-16. Available from URL: http://www.sapj.co.za/index.php/SAPJ/article/view/268 (Accessed 13.05.2011).

Name and business address of applicant: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview Tel.: +27 11 021 4155. www.inovapharma.co.za. For full prescribing information, refer to the package insert. Further information is available on request from iNova Pharmaceuticals or from your healthcare professional. IN543/11