Musculoskeletal Pain

IKE DHIAH R

Prepared for
COMMUNITY PHARMACY I 2016-2017
DEFINITION
Pain is an unpleasant subjective experience that is the net effect of
a complex interaction of the ascending and descending nervous
systems involving biochemical, physiologic, psychological, and
neocortical processes.
Pain can affect all areas of a persons life including sleep, thought,
emotion, and activities of daily living. Since there are no reliable
objective markers for pain, the patients are the only ones to
describe the intensity and quality of their pain.
MUSCULOSKELETAL PAIN
Tendon

Ligament

Synovial Fluid
IFFERENTIAL DIAGNOSIS
TREATMENT GOALS
Decreasing the subjective intensity (severity) and duration of the
pain
Restoring function of the affected area
Preventing reinjury and disability
Preventing acute pain from becoming chronic persistent pain
ASSESMENT OF PAIN
1-3 Mild
4-6 Moderate
7-10 Severe
ARTHRITIS
GOUT OSTEOARTHRITIS
METHYL SALICYLATE
Rubefacient
Vasodilation of cutaneous vasculature Reactive hyperemia
Increase in blood pooling and/or flow is accompanied by an
increase in localized skin temperature counterirritant effect
Fingertips Unit
SYSTEMIC ANALGESICS
Acetaminophen and NSAIDs are commonly used for
musculoskeletal disorders
Scheduled dose of nonprescription strengths are instituted early in
the course of an injury, followed by quick tapering of dose and
interval as the injury improves
1-3 days
Limited to 7 days of self care
CAUTION IN NSAID USES
Avoid using Acetaminophen in patients with liver dysfunction
NSAIDs are associated with
Increased risk of gastrointestinal bleeding, ulceration, and perforation
Increased risk of cardiovascular events
Compromise renal function (especially in patients with impaired renal
function, dehydration, heart failure, liver dysfunction, those taking ACE
Inhibitor, and elderly)

Use the lowest effective dose for the shortest duration of time
ANALGESIC LADDER
(WHO)

Moderate-
Severe
Strong
Non opioid Weak opioid opiod +
OR non-opioid
Weak opioid
Mild- + non-
opioid Severe
Moderate
DEFINE TREATMENT BASED ON PAIN
INTENSITY
 Summary
harmacologic Therapy
for OA
steoarthritis Medication Commonly Used
Osteoarthritis Medication Commonly Us
Hyperuricem
ia
and Gout
34
STATINS AND MUSCLE RELATED SYMPTOMS

Adverse effect of Statin

Delayed onset
PATIENT EDUCATION
REFERENCES
Herchberg, et al. American College of Rheumatology 2012 Recommendations for the Use of
Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee.
Arthritis Care & Research Vol. 64, No. 4, April 2012, pp 465474
Brevik H, et al. Assessment of Pain. British Journal of Anaesthesia 101 (1):17-24 (2008)
Chisholm-Burns M, Schwinghammer T, Wells B, et al. Pharmacotherapy Principles and Practice.
3rd ed. Columbus, OH: McGraw-Hill; 2013.
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update for clinicians: a scientific statement from the American Heart Association. Circulation.
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An Evidence-Based Update of Nonsteroidal Anti-Inflammatory Drugs. 2007. Clinical Medicine &
Research Volume 5 Number 1:19-34
Chisholms-Burn MA, et al. Pharmacotherapy: Principle and Practice. 2008. McGrawHill. New York
Linn WD, Wofford MR. Pharmacotherapy in Primary Care. 2009. McGrawHill. New York
DiPiro JT. Pharmacotherapy: A Pathophysiologic Approach. 2014. McGrawHill. New York
Berardi RR. Handbook of Nonprescription drugs. 16 th edition. 2009. American Pharmacists
Association