Pain treatment and care

MANAGEMENT OF MUSCULOSKELETAL PAIN AND INFLAMMATION WITH ORAL TREATMENT

Doctors choose an analgesic based on the type and duration of pain and on the likely benefits and risks. Most analgesics are effective for pain due to tissue damage (due to the ordinary injury of tissues) but are less effective for pain due to nerve damage (due to damage or dysfunction of the nerves, spinal cord, or brain), which often requires different medicines.21

Paracetamol and aspirin are well-known analgesics and probably an integral part of the first aid kit in most homes. They are available without a prescription. These medicines are often the preferred agents for treating pain. People do not become physically dependent on these medications or tolerant of their pain-relieving effects.21 Paracetamol may be used on its own, or in combination with other analgesics such as nonsteroidal anti-inflammatory agents or muscle relaxants for enhanced pain relief. Paracetamol works centrally in the central nervous system and peripherally (the rest of the body) to provide effective pain relief.22-25 Paracetamol does not have an anti-inflammatory effect, does not affect the blood’s ability to clot and does not irritate the stomach lining. It appears to be a well-tolerated medicine. However, high doses can lead to liver damage, which may be irreversible. People with a liver disorder should use lower doses than those usually prescribed.21

Aspirin has been around for about 100 years and provides about 4 to 6 hours of moderate pain relief. Aspirin can irritate the stomach lining and is sometimes combined with an antacid to reduce the effect. Aspirin should be avoided in children and teenagers due to the risk of developing Reye syndrome. Aspirin may aggravate asthma and may also increase the risk of bleeding (it makes platelets less likely to help blood clot).21

Nonsteroidal anti-inflammatory agents (NSAIDs) relieve pain, but they may also reduce the inflammation that often accompanies and worsens pain. Examples of NSAIDS include ibuprofen and diclofenac. NSAIDs may be used on their own or may be combined with paracetamol. NSAIDs may also be co-prescribed with muscle-relaxants such as orphenadrine with opioids.21,25 Although widely used, NSAIDs can have side effects, sometimes serious ones. All NSAIDs have the potential to irritate the stomach’s lining and cause digestive upset (such as heartburn, indigestion, nausea, bloating, diarrhoea, and stomach pain), peptic ulcers and bleeding.21

Opioid analgesics are effective for many different types of pain. Usually, they are the strongest analgesics and suitable for more severe pain, such as pain after surgery or pain after a fracture or burn.21 Opioids are prescribed with care, as they have many side-effects such as drowsiness and constipation, confusion, nausea and vomiting, and have been reported to have an abuse potential.21

Numerous painful conditions have associated muscle spasms, e.g. neck pain, lower back pain and tension headaches. Poor posture and muscle overuse may also cause painful muscle spasms.12,17,25 Pain and muscle spasms can create a vicious cycle, where pain causes muscle contraction, which can lead to more pain.17 Muscle relaxants relieve the muscle spasm, and thereby also relieve the pain to restore normal muscle function and range of movement to allow you to resume your normal daily activities.17,24,25 Examples of muscle relaxants are orphenadrine, methocarbamol and cyclobenzaprine.25

Orphenadrine is the active ingredient in South Africa’s most prescribed muscle relaxant brand.7,26 Orphenadrine gets to works quickly, within 1 hour, to relieve pain and muscle spasms.25 It works centrally in the brain to interrupt the reflex pathways which cause muscle contraction and pain.24,27 It is effective against a wide range of muscle spasms and keeps on working for 12 to 24 hours after a dose.17,25,27

Methocarbamol and cyclobenzaprine also gets to work within 1 hour. Methocarbamol’s duration of action is 4-5 hours, while the extended release cyclobenzaprine formulation has a duration of action of > 24 hours.25,28

Muscle relaxants may be combined with an analgesic such as paracetamol. A combination of orphenadrine and paracetamol may be useful when faster, additional pain relief is required. The addition of paracetamol to orphenadrine has been shown to get to work within
30 minutes, to enhance the pain killing effect and to prolong the duration of action of the medication.24,25

Muscle relaxants such as orphenadrine may be co-prescribed with NSAIDs if additional anti-inflammatory action is required.25