Self-Care 2025: Musculoskeletal Pain

Where are myalgias located?

Muscles

Where is bursitis located?

Bursae within joints

What are sprains and where are they located?

Stretching or tearing of a Ligaments within a joint

What are strains and where are they located?

Hyperextension of a tendon or muscle (Strain has a T like tendon)

Where is osteoarthritis located?

Weight-bearing joints, knees, hips, lower back, hands

Acute pain is defined as

Pain lasting <4 weeks

Subacute pain is defined as:

Pain experienced for up to 3 months after acute pain

Chronic pain is defined as:

Pain lasting 3 or more months

Which musculoskeletal disorder is associated with the development of joint deformities?

Osteoarthritis

Which musculoskeletal disorder is experienced as a dull, constant ache with occasional weakness and fatigue of muscles?

Myalgia

Which musculoskeletal disorder is experienced as a dull joint pain relieved by rest?

Osteoarthritis

For which musculoskeletal disorders is elimination of cause a primary treatment?

Myalgia, Tendonitis

For which musculoskeletal disorders is heat helpful?

Myalgia, Osteoarthritis

For which musculoskeletal disorders is RICE recommended?

Sprain, Strain

For which musculoskeletal disorders is ice recommended?

Tendonitis, Sprain, Strain

For which musculoskeletal disorders are protective wraps recommended?

Sprain, Strain

For which musculoskeletal disorder is continuous light-moderate exercise recommended?

Osteoarthritis

For which musculoskeletal disorders is stretching NOT as helpful?

Bursitis, Osteoarthritis

For which musculoskeletal disorder is weight loss recommended?

Osteoarthritis

Which musculoskeletal disorder is characterized by initial severe pain with continued pain upon movement and at rest, as well as muscle weakness and loss of some function

Strain

What are the exclusions for self-treatment of musculoskeletal pain?

-Sever pain (>6)

-Pain that last >10 days

-Pain that continues >7 days after starting topical analgesic

-Increase/Change in intensity or character of pain

-Pelvic or abdominal pain (except dysmenorrhea)

-Accompanying N/V, fever, or other signs of systemic infection/disorder

-Visually deformed joint, abnormal movement, weakness in any limb, numbness or suspected fracture

-Pregnancy

-<2 yo

-Back pain and loss of bowel/bladder control

What are the treatment goals for a patient with musculoskeletal pain?

Decreasing the subjective pain intensity

Decreasing the duration of pain

Restoring function to affected area(s)

Prevent reinjury and disability

Prevent acute pain from becoming chronic persistent pain

When should you follow up with a patient after making recommendations for musculoskeletal injuries EXCEPT osteoarthritis?

7 days

When should you follow up with a patient after making recommendations for osteoarthritis?

1 month

What dose R in RICE stand for?

Rest

Rest injured area until pain is decreased (1-2 days)

What does I in RICE stand for?

Ice

Ice the area for 15-20 minutes 3-4 times daily for 1-3 days

What does C in RICE stand for?

Compression

Compression application to the area (be careful not to wrap too tight)

What does E in RICE stand for?

Elevation

Elevate injury above the level of the heart

Ibuprofen Dosing and Max Dose

200-400 mg Q4-6H

Max: 1200 mg/day

Naproxen Dosing and Max Dose

220 mg Q8-12H

Max: 660 mg/day

May take 1 to 2 tabs for the first dose

Acetaminophen Extra Strength Dosing and Max Dose

500-1000 mg Q6H

Max: 3000 mg/day

Acetaminophen Regular Strength Dosing and Max Dose

325-650 mg Q4-6H

Max: 3000 mg/day

What boxed warnings exist for OTC NSAIDs?

Serious CV thrombotic events; serious gastrointestinal bleeding, ulcerations, and perforations

What is the Triple Whammy?

NSAIDs + ACEI/ARB + Diuretics

Risk of kidney damage

Heat should not be applied to ___ areas because it can intensify vasodilation and exacerbate vascular leakage

Inflamed

Heat wraps should be worn over a towel or layer of clothing in patients older than ___

55 (seniors)

Other Counseling Points about Heat Products

-Don't wear overnight/sleeping

-If discomfort or burning sensation occurs, remove immediately

-Don't apply to damaged skin or wounds

-Avoid use concurrently with topical analgesics/counterirritants

How does TENS work? (3 theories)

1-The pulses block pain messages from reaching the brain

2-The stimulation can trigger the body to produce more endorphins (a natural pain killer)

3-It improves blood circulation

Duration and frequency of TENS units

Use 15-30 mins up to 3 times daily

What should you avoid when placing a TENS unit?

-Throat, chest, head, or carotid arteries

-Open wounds, rashes, inflamed skin, cancerous lesions, areas of altered sensation, over topical analgesics.

Which patients shouldn't use TENS therapy?

Internal or attached medical devices

Pregnancy

Children

Osteoarthritis of knee or hip

What is the purpose of counterirritants?

Produces a less severe pain to distract from a more severe pain.

Mechanism of action of Methyl salicylate

Rubifacients

Frequency and duration of methyl salicylate use for pain

No more than 4 times daily prn, up to 7 days

Mechanism of action of Camphor and Menthol

Produces Cooling Sensations

Frequency and duration of camphor use for pain

No more than 4 times daily prn, up to 7 days

Frequency and duration of menthol use for pain

No more than 4 times daily prn, up to 7 days

Mechanism of action of Histamine Dihydrochloride and Methyl Nicotinate

Causes Vasodilation

Mechanism of action of Capsaicin/Capsicum

Incites irritation without rubefication.

Frequency and Duration of Capsaicin/Capsicum

Acute Pain: No more than 4 times daily prn, up to 7 days (same as other counterirritants)

Chronic Pain: Apply 3-4 times/day for duration of pain

Which counterirritants have dual action?

-Camphor and Menthol

-At low concentrations they are topical anesthetics (and analgesic for camphor)

-At high concentrations they are counterirritants

Counseling points for topical counterirritants

Apply a thin layer and rub into the affected area until you can't see the product;

Wash hands after application and avoid touching eyes or mucous membranes;

Do not use tight dressings or bandages over treated area;

Do not use on children 2 or younger

Frequency and duration of topical diclofenac use for pain

4 times daily, up to 21 days (may take up to 7 days to work)

Topical analgesics should not be applied to:

wounded, broken, or irritated skin

Topical analgesic that works by inhibiting conduction of nerve impulses

lidocaine

Frequency and Duration of Lidocaine

-Apply every 6-8 hours prn, don't exceed 3 applications in 24 hours

-Use for max 7 days