What is the standard treatment for musculoskeletal (muscle and skeletal) pain?

From the Guidelines

The standard treatment for musculoskeletal pain should begin with non-pharmacological approaches combined with topical nonsteroidal anti-inflammatory drugs (NSAIDs) as first-line therapy, as recommended by the American College of Physicians and American Academy of Family Physicians 1. The treatment approach should focus on reducing or relieving symptoms, including pain, improving physical function, and improving the patient's treatment satisfaction.

• Non-pharmacological approaches include rest, ice for acute injuries (15-20 minutes several times daily), and gentle movement as tolerated.
• Topical NSAIDs, such as diclofenac gel (1% applied to affected area 3-4 times daily), can provide localized relief with fewer systemic side effects.
• Oral NSAIDs, like ibuprofen (Advil, Motrin) at 400-800mg three times daily with food or naproxen (Aleve) at 220-500mg twice daily, or oral acetaminophen at 325-650mg every 4-6 hours (maximum 3000mg daily) can be used as alternative options 1.
• Physical therapy focusing on stretching, strengthening, and proper body mechanics is crucial for long-term recovery and prevention.
• Heat therapy (15-20 minutes several times daily) works well for chronic pain by increasing blood flow and relaxing muscles. It is essential to note that opioids, including tramadol, should be avoided as a treatment option for acute musculoskeletal pain due to the risk of prolonged opioid use and adverse events 1.

From the FDA Drug Label

NSAID medicines are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as: different types of arthritis menstrual cramps and other types of short-term pain Naproxen has been studied in patients with rheumatoid arthritis, osteoarthritis, juvenile arthritis, ankylosing spondylitis, tendonitis and bursitis, and acute gout

The standard treatment for musculoskeletal pain includes NSAIDs such as naproxen.

• Naproxen has been shown to be effective in treating various types of musculoskeletal pain, including:
  • Rheumatoid arthritis
  • Osteoarthritis
  • Ankylosing spondylitis
  • Tendonitis and bursitis
  • Acute gout 2 2

From the Research

Standard Treatment for Musculoskeletal Pain

The standard treatment for musculoskeletal pain typically involves a combination of pharmacological and non-pharmacological approaches.

• Topical non-steroidal anti-inflammatory drugs (NSAIDs) are often recommended as a first-line treatment for acute and chronic musculoskeletal pain 3, 4.
• Multimodal analgesia and multidisciplinary approaches are fundamental elements of effective management of musculoskeletal pain 5.
• Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions 6.
• Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 6.
• Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 6.

Treatment Options

Treatment options for musculoskeletal pain include:

• Topical NSAIDs, such as diclofenac, ibuprofen, and ketoprofen 4
• Acetaminophen 6, 7
• Nonselective NSAIDs 6
• Selective cyclooxygenase-2 NSAIDs 6
• Opioids, such as tramadol and tapentadol, for severe or refractory acute pain 6
• Nerve growth factor antibodies, a new class of agents under clinical investigation for the treatment of osteoarthritis 7

Considerations

When treating musculoskeletal pain, it is essential to consider the following:

• The balance between the benefits and harms of an intervention 3
• The quality of the evidence 3
• Patient preferences and values 3
• Resource utilization 3
• The potential for adverse events, such as gastrointestinal bleeding, cardiovascular disease, and chronic renal disease 6