What are the treatment options for chronic Musculoskeletal (MSK) pain?

From the Guidelines

Treatment options for chronic musculoskeletal pain should prioritize non-pharmacological approaches, including physical therapy, regular moderate physical activity, cognitive behavioral therapy, and complementary therapies, as first-line treatments. These approaches can be effective in managing chronic musculoskeletal pain and improving quality of life, as supported by recent guidelines and studies 1.

Some key non-pharmacological treatments include:

• Physical therapy focusing on strengthening exercises, stretching, and proper body mechanics
• Regular moderate physical activity like walking or swimming for 30 minutes most days
• Cognitive behavioral therapy to address pain-related thoughts and behaviors
• Complementary therapies such as acupuncture, massage, and mindfulness meditation

For medications, acetaminophen (500-1000mg every 6 hours, maximum 3000mg daily) is often tried first for safety, followed by NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (500mg twice daily) at the lowest effective dose for the shortest duration due to gastrointestinal and cardiovascular risks 1. Topical agents like diclofenac gel (apply to painful area 4 times daily) or lidocaine patches (apply for up to 12 hours daily) provide localized relief with fewer systemic effects. For more severe pain, duloxetine (30-60mg daily) or amitriptyline (10-25mg at bedtime) may help by modulating pain signals. Opioids should generally be avoided for chronic musculoskeletal pain due to limited evidence for long-term benefit and significant risks of dependence and side effects 1. A multimodal approach combining several treatments typically works best as it addresses different aspects of pain processing and allows for lower doses of any single intervention.

From the FDA Drug Label

CLINICAL STUDIES General Information Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout In patients with osteoarthritis, the therapeutic action of naproxen has been shown by a reduction in joint pain or tenderness, an increase in range of motion in knee joints, increased mobility as demonstrated by a reduction in walking time, and improvement in capacity to perform activities of daily living impaired by the disease Naproxen has been studied in patients with mild to moderate pain secondary to postoperative, orthopedic, postpartumepisiotomy and uterine contraction pain and dysmenorrhea. Onset of pain relief can begin within 1 hour in patients taking naproxen and within 30 minutes in patients taking naproxen sodium

Tratamiento para dolor crónico MSK: El naproxen puede ser una opción para el tratamiento del dolor crónico musculoesquelético (MSK), ya que ha demostrado reducir el dolor y la inflamación en pacientes con osteoartritis, artritis reumatoide y otras afecciones musculoesqueléticas.

• Beneficios: Reducción del dolor y la inflamación, mejora de la movilidad y la capacidad para realizar actividades diarias.
• Precauciones: Es importante tener en cuenta los posibles efectos secundarios, como problemas gastrointestinales, y seguir las instrucciones de dosificación recomendadas por el médico 2.

From the Research

Treatment Options for Chronic Musculoskeletal (MSK) Pain

• Exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain, with moderate to strong evidence 3
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids can reduce pain in the short-term, but the effect size is modest and the potential for adverse effects needs careful consideration 3, 4, 5
• Corticosteroid injections can provide short-term pain relief for patients with knee and shoulder pain, but the optimal dose, intensity, and frequency of application are unclear 3

Pharmacological Treatments

• Acetaminophen, NSAIDs, and opioids are common pharmacologic treatments for osteoarthritis (OA) and chronic MSK pain, but their efficacy and safety vary 4, 5
• NSAIDs may be effective for short-term pain reduction and disability improvement in acute low back pain, but the magnitude of the effects is small and probably not clinically relevant 6, 7
• Selective COX-2 inhibitors may have fewer side effects than traditional NSAIDs, but their long-term safety and efficacy are uncertain 6, 7

Non-Pharmacological Interventions

• Exercise therapy and psychosocial interventions can be effective for relieving pain and improving function for musculoskeletal pain, and may be a useful adjunct to pharmacological treatments 3
• A comprehensive treatment plan for chronic MSK pain may include a combination of pharmacological and non-pharmacological interventions, tailored to the individual patient's needs and preferences 3, 5