Conventional Treatment of Musculoskeletal Problems

General: Musculoskeletal problems are generally managed with medications that reduce pain and inflammation. In severe cases, surgery may be necessary to repair damage.

In order to properly manage pain and prevent joint damage, individuals should take their medications as prescribed by their healthcare providers. Individuals with musculoskeletal problems should also tell their healthcare providers if they are taking any other drugs (prescription, over-the-counter, or dietary supplements) because they may interfere with treatment.

Corticosteroids: Corticosteroids, such as prednisone (Deltasone ®) and methylprednisolone (Medrol ®), are occasionally used to reduce inflammation and pain and slow joint damage caused by musculoskeletal problems. These drugs are generally very effective when used short-term. However, if used for many months to years, these drugs may become less effective and serious side effects may develop. Side effects may include easy bruising, thinning of bones, cataracts, weight gain, a "moon" face, and diabetes.

Corticosteroids are usually prescribed for a certain amount of time, and then the individual is gradually tapered off the medication. Individuals should not stop taking corticosteroids suddenly or change their dosages without first consulting their healthcare providers.

Nonsteroidal anti-inflammatory drugs (NSAIDs): Nonsteroidal anti-inflammatory drugs (NSAIDs) have been used to relieve pain and inflammation caused by musculoskeletal problems. Commonly used over-the-counter NSAIDs include ibuprofen (Advil ® or Motrin ®) and naproxen sodium (Aleve ®). Higher doses of these drugs are also available by prescription. Commonly prescribed NSAIDs include diclofenac (Cataflam ® or Voltaren ®), nabumetone (Relafen ®), and ketoprofen (Orudis ®). NSAIDs may be taken by mouth, injected into a vein, or applied to the skin. These medications are generally taken long term to manage symptoms.

The frequency and severity of side effects vary among NSAIDs. The most common side effects include nausea, vomiting, diarrhea, constipation, decreased appetite, rash, dizziness, headache, and drowsiness. The most serious side effects include kidney failure, liver failure, ulcers, heart-related problems, and prolonged bleeding after an injury or surgery. About 15% of patients who receive long-term NSAID treatment develop ulcers in the stomach or duodenum.

Pain relievers: Over-the-counter (OTC) pain relievers used in the treatment of musculoskeletal disorders include acetaminophen (Tylenol ®). Prescription pain relievers, including tramadol (Ultram ®), have been used to reduce pain caused by musculoskeletal problems. Although this drug, which is available by prescription, does not reduce swelling, it has fewer side effects than NSAIDs. Tramadol is generally taken as a short-term treatment to reduce symptoms of flare-ups.

Narcotic pain relievers, such as acetaminophen/codeine (Tylenol with Codeine ®), hydrocodone/acetaminophen (Lorcet ®, Lortab ®, or Vicodin ®), or oxycodone (OxyContin ® or Roxicodone ®), may be prescribed to treat severe musculoskeletal pain. However, they do not reduce swelling. These medications are only used short-term to treat flare-ups. Common side effects include constipation, drowsiness, dry mouth, and difficulty urinating. Narcotic pain relievers should be used cautiously because individuals may become dependent upon them.

Selective COX-2 inhibitors: Celecoxib (Celebrex ®) has been taken by mouth to reduce pain and inflammation caused by musculoskeletal problems such as osteoarthritis. Celecoxib is currently the only COX-2 inhibitor that is approved by the U.S. Food and Drug Administration (FDA). Celecoxib is generally taken long-term to manage symptoms.

COX-2 inhibitors have been linked to an increased risk of serious heart-related side effects, including heart attack and stroke. Selective COX-2 inhibitors have also been shown to increase the risk of stomach bleeding, fluid retention, kidney problems, and liver damage. Less serious side effects may include headache, indigestion, upper respiratory tract infection, diarrhea, sinus inflammation, stomach pain, and nausea.

Topical pain relievers: Topical pain relievers are creams, ointments, gels, and sprays that are applied to the skin. Many over-the-counter (OTC) pain relievers may temporarily help reduce pain caused by osteoarthritis. Products such as Aspercreme ®, Sportscreme ®, Icy Hot ®, and Ben-Gay ® may help reduce arthritis pain. Capsaicin cream, which is made from the seeds of hot peppers, may reduce pain in joints that are close to the skin surface, such as the fingers, knees, and elbows. Lidocaine patches (Lidoderm ®) may also be used. Lidocaine is an anesthetic when applied topically and may decrease pain associated with musculoskeletal problems.

Antidepressants: Some individuals with musculoskeletal problems may also suffer from depression. Commonly prescribed anti-depressants for arthritis patients include amitriptyline, nortriptyline (Aventyl ®, Pamelor ®), and trazodone (Desyrel ®). These drugs may also help with nerve pain associated with musculoskeletal disorders. Side effects of antidepressant medications include drowsiness, fatigue (excessive tiredness), constipation, dry mouth, and blurred vision.

Lifestyle changes: Many lifestyle changes, including regular exercise, weight management, and consumption of a healthy diet may help reduce symptoms of musculoskeletal problems. A healthcare provider may recommend a physical therapist, nutritionist, or registered dietician to help determine the best treatment plan for the individual.

Individuals with musculoskeletal problems such as osteoarthritis or rheumatoid arthritis should wear comfortable footwear that properly supports their weight. This may reduce the amount of strain put on the joints during walking.

Individuals with musculoskeletal problems may require canes, walkers, or other devices to help them get around. If the hands are severely affected, braces may be beneficial. Individuals should talk to their healthcare providers about assistive devices that are available.

Individuals with musculoskeletal problems should maintain good posture. This allows the body's weight to be evenly distributed among joints.

Cool compress or ice pack: Applying a cool compress or ice pack to the affected joint during a flare-up may help reduce swelling and pain.

Heat: Applying a hot pack to affected joints may help reduce pain, relax muscles, and increase blood flow to the joint. It may also be an effective treatment before exercise. Alternatively, individuals may take a hot shower or bath before or after exercise to help reduce pain.

Fusing bones: If there is serious joint damage, the bones of a joint, such as the ankle, may be surgically fused together in a procedure called arthrodesis. This surgery helps increase stability and reduces pain. However, the joint no longer has any flexibility and cannot bend or move.

Joint replacement surgery: In some cases, individuals with osteoarthritis suffer from permanent joint damage. In such instances, joint replacement surgery may be necessary. During the procedure, the damaged joint is surgically removed, and it is replaced with a plastic or metal device called a prosthesis. The most commonly replaced joints are the hip and knee, but other joints, including the elbow, shoulder, finger, or ankle joints can be replaced as well.

Joint replacement surgeries are generally most successful for large joints, such as the hip or knee. Researchers estimate that hip or knee replacements last at least 20 years in 80% of patients. After a successful surgery and several months of rehabilitation, individuals are able to use their new joints without pain.

As with any major surgery, there are risks associated with joint replacements. Patients should discuss the potential health risks and benefits of surgery with their healthcare providers.

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