Musculoskeletal Pain Lecture

Question 1

What are the six types of musculoskeletal pain?

Answer 1

Myalgia
Tendonitis/Bursitis
Sprains/Strains
Cramps
Osteoarthritis
Rheumatoid Arthritis

Question 2

What is myalgia?

Answer 2

Muscle pain
Dull, constant ache, possibly accompanied by weakness or fatigue
Often caused b some type of trauma but can be alcohol-drug induced
Made worse by contracting or using affected muscles

Question 3

What is tendonitis/bursitis?

Answer 3

Inflammationof the tendon or the bursa
Overuse of joint or tendon
Site can be warm, swollen, possible crepitus
Can either be an acute injury or caused by excessive wear and tear on a joint

Question 4

What is a sprain?

Answer 4

Joint/ligament (bone-to-bone)
Caused by hyperextension of the ligament
Usually caused by an acute injury
ACL tear

Question 5

What is a strain?

Answer 5

Muscle/Tendon (muscle-to-bone
Caused by extensive strech of the muscle
Usually caused by an acute injury
Pulled hamstring

Question 6

What is a cramp?

Answer 6

Overexertion of the muscles
Affected muscle is often firm to the touch but visibly distorted
Commonly occurs at night or when working in a hot environment

Question 7

What is osteosrthritis?

Answer 7

Occurs in weight-bearing joints
Caused by the destruction of the cartilage between bones
Don’t always see inflammation, but have crepitus
Unilateral injury

Question 8

What is rheumatoid arthritis?

Answer 8

Autoimmune disorder
Symmetrical swelling in the fingers, wrists or feet
Occurs over weeks or months for no reason

Question 9

What are exclusions for self-treatment?

Answer 9

Severe pain
Pain lasting longer than 2 weeks
Pain continues for 10 days after starting treatment
Increased intensity or change in pain
Pelvic or ab pain
Accompanying nausea, vomiting, fever or other signs of infection
Deformed joint, limb weakness or other fracture
Third trimester of pregnancy
Less than 7 yo

Question 10

Nonpharmacologic therapies?

Answer 10

Rest
Eliminate underlying cause of pain
Light exercise and weight loss
Protective wraps/cane/crutches
RICE therapy

Question 11

What is RICE therapy?

Answer 11

Rest
Ice
Compression
Elevation

Heat (15-20 mins, 3-4 times daily)

Question 12

What are systemic meds?

Answer 12

NSAIDs, acetaminophen, salicylates

Question 13

What are topical meds?

Answer 13

Methyl salicylate
Camphor
Menthol
Capsaicin
"counter-irritants"

Question 14

NSAIDs are preferred with what conditions?

Answer 14

Inflammatory

Question 15

Acetaminophen is better with what conditions?

Answer 15

Non-inflammatory

Question 16

MAX duration of self therapy is?

Answer 16

10 days

osteoarthritis - 1 month at max dose

Question 17

How do topical counterirritants work?

Answer 17

Causing mild, local, inflammatory reactions
--> ignore the original pain
Mainly for acute injuries
NO heat
Apply 3-4 times a daily for up to 7 days

Question 18

What is methyl salicylate?

Answer 18

Oil of Wintergreen
10-60% strength
MOA: Rubefacient
Children may think it is candy due to its sent
No aspirin or salicylate allergy or children with asthma

Question 19

What is MOA of rubefacient?

Answer 19

Causes vasodilation of cutaneous vasodilation

Increases blood flow at the site of application, which increases the temp, which causes the counterirritant effects

Question 20

what is camphor?

Answer 20

3-11% strength
Stimulates nerve endings in skin
Helps mask the deeper pain in the skin to provide relief
Rubefacient when applied vigorously

Question 21

Camphor side effects and warning?

Answer 21

Nausea, vomiting, colic, headache, dizziness, delirium, convulsions, and coma
Putting camphor in nostrils of infant would cause immediate respiratory collapse

Question 22

What is menthol?

Answer 22

Derived from peppermint oil
1.25-16% strength
Stimulates the nerves in the skin that sense cold
After the feeling of coolness, you then get a feeling of warmth at the site
Children could think its candy due to smell

Question 23

Stop menthol if?

Answer 23

Develops a rash, excessive burning, stinging, swelling at site of use

Question 24

What is capsaicin?

Answer 24

Substance P
.025-.25% strength
Chronic-use med
Works by causing a warm-burning sensation at the site of use
After 1-6 weeks of regular application, the patient can experience more complete pain relief
Arthritis or nerve pain disorders

Question 25

Side effects of capsaicin?

Answer 25

Burning sensation at site

40-70% of patients but goes away after a few weeks

Question 26

What is glucosamine?

Answer 26

Endogenous: synthesis of cartilage
- glucosamine sulfate used in osteoarthritis
Dose: 1500 mg daily
Doesn’t start working for 8 weeks

Question 27

Caution for glucosamine?

Answer 27

Shellfish allergies, diabetes, and bleeding disorders

Question 28

What is chondroitin?

Answer 28

Cartilage formation –> slow breakdown of cartilage
Dose: 800-1200 mg daily
Can cause bleeding in patients taking anticoagulants