1. Musculoskeletal problems

2. 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)

4. 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).

5. 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.

11. 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

13. 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
Good posture, lifting correctly, good mattress
Avoid topical analgesics on mucous membranes, broken skin or irritated skin

14. 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

15. Topical analgesics and anti-inflammatory agents

17. 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

18. 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)

19. 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)

20. 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

21. Topical analgesics: counterirritants and rubefacients

22. 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