Musculoskeletal problems
Myalgia OTC analgesics should be started soon after the injury. Adjunctive: heat, massage. Remobilisation after injury healed is important, otherwise: weak, tight, overly contracted muscles, trigger points may arise R.I.C.E: beneficial. ice, vapo-coolant spray, trigger point injections (= Local anaesthetic to facilitate mobilisation)
Periarticular Pain: Injury or inflammation to the tissues surrounding the joint ( joint capsule, ligaments, tendons, bursae) Localised tenderness, pain associated with movement of structure. knee, shoulder, elbow Responds well to OTC analgesics and limitation of movement A bursa (plural bursae) is a small fluid-filled sac lined by synovial membrane with an inner capillary layer of viscous fluid (similar in consistency to that of a raw egg white).
Arthralgia: Joint pain often caused by synovitis (inflammation of synovial membrane). Cartilage loss may occur (e.g. in DJD, RA). Osteoarthritis (DJD) In wt bearing joints: hips, knee, lumbar spine Paracetamol is analgesic of choice, wt loss For acute flares: NSAIDs, local heat Reumatoid Arthritis (RA) mainly: multiple joints, fingers, hands, wrist and feet joints warm, red, swollen, motion limited > deformity more than OTC (NSAIDs): education, physical therapy, Eat plenty of sulphur containing foods, such as garlic and onion, and eggs. Sulphur is needed for the repair and rebuilding of bone, cartilage and connective tissue, and aids in the absorption of calcium. Eat plenty of green leafy vegetables, and vegetables of every colour, non-acidic fresh fruit. Eat whole grains (except wheat) such as spelt, kamut, millet and brown rice. Eat oily fish, such as mackerel, herring, sardine, pilchard (avoid the tomato sauce in the tins of fish). Eat fresh (not dried or tinned) pineapple when available as the enzyme Bromelain found in pineapple will help reduce inflammation. Take a tablespoon of linseeds with a couple of glasses of room temperature water every day. Apple cider vinegar is very good for people with arthritis. Reduce saturated fat from animals in your diet and avoid fried foods. Avoid all milk and other dairy produce. You may be alright with goats or sheep's yoghurt???? Avoid red meat. Avoid the nightshade family of vegetables (peppers, aubergine or eggplant, tomatoes and white potatoes – also tobacco). The solanine found in these foods can cause pain in the muscles to susceptible people. Avoid table salt (sodium chloride) but include the natural sodium found in foods such as celery – this is needed to keep calcium in solution and not sit on top of your joints. Get your iron from food, but ensure your multi-mineral supplements does not contain extra iron (unless your Doctor tells you you’re anaemic) – there is some evidence iron may be involved in pain, swelling and joint destruction. You do need some iron though, so eat broccoli, blackstrap molasses, beetroot, peas and, if you are Blood Type O, a little lean organic red meat if this appears to suit you.
Practical points First-aid treatment of sprains and strains: R I C E: R: Rest I: Ice/cooling C: Compression (priority) E: Elevation Duration: at least 48 hr Aim: to prevent swelling reduce pain faster recovery
Practical points Heat: effective, but after the acute phase (2 days after injury) Comforting and effective in chronic conditions such as back pain Hot-water bottle, heat pack, or infrared lamp http://www.youtube.com/watch?v=1Eka0rsj43E Good posture, lifting correctly, good mattress Avoid topical analgesics on mucous membranes, broken skin or irritated skin
Topical analgesics and anti-inflammatory agents Creams, gels, ointments, and transdermal patches containing NSAIDs Widely used, and as effective as oral preparations Ibuprofen, felbinac, ketoprofen, diclofenac and piroxicam Concentrate in the affected tissue (any systemic absorption?) Use up to 4 times a day Use cautiously if there is adverse effects related to aspirin, e.g. Urticaria, hypersensitivity or asthma
Topical analgesics and anti-inflammatory agents
Topical analgesics: counterirritants and rubefacients Have been available for many years They cause local vasodilation ↑ blood flow warmth and pressure feeling distract the feeling of pain Counterirritants: produce mild skin irritation Rubefacients: cause reddening and warming Simple rubbing or massaging aid in their absorption and action
Topical analgesics: counterirritants and rubefacients Many available formulations, often incorporating a mixture of ingredients Most pharmacists and customers have their own favourite product To be used up to 4 times a day Living alone spray dosage form is more convenient for back and shoulders (no need for massage)
Topical analgesics: counterirritants and rubefacients Methyl salicylate: One of the most widely used counterirritants. Originally taken from wintergreen Effective in acute pain Available in concentrations 10 to 60% formulations Nicotinates: e.g. Methyl nicotinate and hexyl nicotinate Absorbed through skin reddening and warmth When applied at large surface area rare risk of systemic adverse effects (dizziness)
Topical analgesics: counterirritants and rubefacients Menthol: Mild counterirritant and antipruritic Gives a feeling of coolness then warmth sensation Capsaicin: Capsicum extracts: capsaicin capsicum and capsicum oleoresin Produce a feeling of warmth when rubbed on skin (without reddening because they don’t act on blood vessels) Wash hands after application in order not to transfer the substance mistakenly to eyes and mucus membranes
Topical analgesics: counterirritants and rubefacients
Other treatments Heparinoid and hyaloronidase: Enzymes help to disperse oedematous fluid in swollen areas ↓ swelling and bruising Indicated for: treatment of bruises, bursitis, strains and sprains Chondroitin: improves the symptoms of OA in the knee Glucosamine: Improves the symptoms of OA in the knee, and have a beneficial structural effect on joints 1,500 mg daily dose can be as good as NSAIDs in reducing pain Side effects: rare, including abdominal discomfort, heartburn, diarrhoea and nausea Acupuncture: not for low back pain, beneficial for OA