Musculo-Skeletal Pain

By: Maged Taman

Musculo-skeletal pain is very common. All of us gets aches and pains every now and then. The pain is most likely originate from:

1- Joints: commonly arthritis, by far the most common is degenerative joint disease due to the wear and tear of our cartilages when we got old. These joints are present through all of our extremities as well our neck and back.

2- Muscles: muscle aches are common after exercise and hard work. Muscle sprains and cramps are quite common. Tear of muscles can cause significant pain and diminish mobility of the joints. This commonly occur with tear of one or more of the rotator cuff muscles of the shoulder.

3- Tendons: inflammation of the tendon which is the thin part of the muscle that attach to the bone.

4- Bursa: it is inflammation and swelling of the bursa(a small fluid-filled sac that provides cushioning between bone)

5- Pain due disc material or osteophytes: commonly in the spine etiher on the neck or back a degenerated or slipped disc can cause pressure on the spinal cord or the nerve roots. Local pain or radiating pain and in severe cases compression of the spinal cord with paralysis may occur. Osteophytes may not always produce symptoms and similarly a displace disc may not be compressing the nerve roots or the spinal cord.

6- Bone pain: is usually severe in case of infection, malignancy or fractures.

Treatment of Musculo skeletal Pain:

1- Step 1: is to identify the structure that you are dealing with: a joint, muscle, bone.... and its anatomy like a right knee pain due to arthritis.

2- Step 2: role out emergency or semi-emergency. Decide if you are dealing with a fracture or a septic joint since both are orthopedic semi-emergency. X- ray will show the fracture and aspiration of joint will detect infection. More urgent if the presence of epidural abscess or quada Equina. The first is suspected by the presence of sever pain and tenderness localized in the spine with fever and chills and the later with loss of bladder an bowel functions, weak or or both legs and saddle numbness in the perineal area. Both diseases are diagnosed by MRI back and both are orthopedic emergencies.

3- Step 3: Find if you are dealing with a systemic disease. Determine if the process is localized to small are to suggest local problem or a systemic disease like rheumatoid arthritis, SLE, polymyalgia rheumatic and so forth. In this case find out which disease and treat it according to the guidelines.

4- Step 4: Think of any local measures you can use as heat pack or cold compresses. The latter in the first 2 days of a trauma. bengay or other creams like diclofenac will help with pain control to be rubbed three times a day. Lidoderm patch 5% deliver xylocaine as continuous local numb medications to avoid if the joint is hot since get absorbed to the blood. A local steroid to a frozen shoulder, painful muscle, bursa or trigger point in the muscle is commonly effective.

5-Step 5: medications to control the pain. Anti-inflammatory medications are commonly effective particularly if there is inflammation. They are usually given as a course of 10 days or so. On the other hand for patients have degenerative joint diseases who are commonly old glucosamine-choniritin sulfate is give twice a day a long with around the clock Tylenol about 500 mg with meals and at bed time. If pain no controlled NSAID smallest dose can be given at small dose when the pain is significant about 400 mg of motrin once a day. Alternatively a mild narcotic as ultram 25 mg three times a day as needed or vicodin 5/500 mg every nigh may be given. Treating pain in the elderly is trial and error. Omega fatty acids my also of some help 1 gram twice a day.

6- Step 6: consider muscle relaxants. They are quite effective if patient give history of muscle rigidity or spasms. In examination the muscle is firm or stiff. Flexeril at 5 mg 1/2 tablet every night to the elder as needed and 1 to 2 tablets every night as needed for the younger patients.

7- Step 7: determine if you are dealing with nerve pain: commonly we say reticular pain that is a shouting pain and can be accompanied by numbness is treated differently by neurintin of lyrica start either in low dose then increase gradually the dose. Sciatica is a common form of reticular pain that occur in the legs and commonly shout down all the way to the foot. Surgery of displaced disc or for clearing the arthritis in the back is indicated if pain persists and interfere with daily activities.

8- Step 8: consider physical therapy if condition persist in the next visit. Consider also assistant devices like air cast to a sprained ankle, a crutch for patient with foot fracture. A cane, quadricane or a walker for a patient with chronic arthritis of knees or hips.

9- Step 9: refer to orthopedic doctor or spine center as indicated.