Musculoskeletal Pain Management

Anatomy or structure of the

musculoskeletal system

Function of the musculoskeletal system 2

form
stability
movement to the human body

The musculoskeletal system is comprised of the skeleton

and the muscles that are attached to it.1 In addition,
it also consists of other tissue namely:2

tendons
ligaments
joints (union of 2 or more bones)
cartilage

Muscles
Three types of muscle are found in the body and include:2

Skeletal
These muscles are attached to the skeleton and

contract voluntarily3

Smooth
Smooth muscle contracts involuntarily. eg: digestive
system, blood vessels, bladder airways and female
uterus3

skeletal:

smooth:

Cardiac muscle

This type of muscle is only found in the heart3

cardiac:

What is musculoskeletal pain? 4

Types of musculoskeletal pain

Musculoskeletal pain affects the:

Muscle pain 4,5

bones
muscles
ligaments
tendons
nerves

Muscle pain is most frequently related to:

tension
overuse
muscle injury from exercise or physically demanding work
The pain tends to involve specific muscles and starts during or just after the activity.5

Musculoskeletal pain can be:

acute or chronic
localised or widespread

Tendon and ligament pain 4

Pain in the tendons or ligaments are often caused by injuries such as sprains.

Causes of musculoskeletal pain

Neck and shoulder pain 6

Injury 4
Overuse 4,5
Poor posture or prolonged immobilisation 4
Tension or stress 5

The most common cause is injury to the soft tissues including muscles, tendons
and ligaments found in these areas.
Pain can lead to a stiff neck or shoulder and a loss of range of motion. Headache
may also result.

Lower back pain

Often, no specific cause for the pain can be found. Most lower back pain,
however, generally follows injury or trauma to the back.7

What is tension headache? 8

Tension headaches are one of the most common form of headaches and
occur when the neck and scalp muscles become tense or contract.

Goals of treatment 9

Manage pain

Restore mobility

Hasten recovery so that the patient can resume normal activities as soon as possible

Pain management
Various types of drugs can be used to relieve pain associated with musculoskeletal pain and include:10

Centrally acting skeletal

muscle relaxants
e.g. orphenadrine
(Norflex/Norflex Co)
These agents may be
combined with an
analgesic

Non-opioid analgesics

e.g. paracetamol
These painkillers
are recommended for the
relief of mild to moderate
acute musculoskeletal
pain
Can be used with opioids
to manage more severe
pain

Non-steroidal antiinflammatory drugs

(NSAIDs)
e.g. ibuprofen

Opioid analgesics

e.g. codeine
An opioid
analgesic may
be necessary
to relieve
more severe
musculoskeletal
pain

References: 1. Peters M. British Medical Association A-Z Family Medical Encyclopedia 5th ed. London(UK):Dorling Kindersley;2008; p. 525, 710, 715, 734. 2. Mooar P, reviewer. Biology of the Musculoskeletal System. Merck Manual
Home Edition [Online] Available from URL: http://www.merckmanuals.com/home/sec05/ch058/ch058.html (Accessed 13.05.2011). 3. Freudenrich C. How Muscles Work Discovery Health [Online] Available from URL: http://health.
howstuffworks.com/human-body/systems/musculoskeletal/muscle.htm (Accessed 13.05.2011). 4. Musculoskeletal Pain Cleveland Clinic [Online] Available from URL: http://my.clevelandclinic.org/disorders/musculoskeletal_pain/
hic_musculoskeletal_pain.aspx (Accessed 13.05.2011). 5. Vorvick LJ, et al. Muscle aches: MedlinePlus Medical Encyclopedia [Online] Available from URL: http://www.nlm.nih.gov/medlineplus/ency/article/003178.htm (Accessed
13.05.2011). 6. Shiel WC. Shoulder and Neck Pain. eMedicinehealth.com [Online] Available from URL: http://www.emedicinehealth.com/script/main/art.asp?articlekey=59261&pf=3&page=1 (Accessed 13.05.2011). 7. Low Back Pain
Fact Sheet: National Institute of Neurological disorders and Stroke (NINDS) Available from URL:http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm (Accessed 13.05.2011). 8. Sheth K. Tension headache: MedlinePlus
Medical Encyclopedia [Online] Available form URL: http://www.nlm.nih.gov/medlineplus/ency/article/000797.htm (Accessed 13.05.2011). 9. Bhangle SD, et al. Back pain made simple: an approach based on principles and evidence.
Cleve Clin J Med 2009;76(7): 393-99. 10. Truter I. Musculoskeletal pain. SA Pharm J Jan/Feb 2008;75(1):10-16. Available from URL: http://www.sapj.co.za/index.php/SAPJ/article/view/268 (Accessed 13.05.2011).
Name and business address of applicant: iNova Pharmaceuticals (Pty) Ltd. Co. Reg. No. 1952/001640/07, 15e Riley Road, Bedfordview Tel.: +27 11021 4155. www.inovapharma.co.za. For full prescribing information, refer to the
package insert. Further information is available on request from iNova Pharmaceuticals or from your healthcare professional. IN543/11