Musculoskeletal Disorders and Pain Management

Phytotherapy for Musculoskeletal Disorders

• This presentation focuses on herbal therapies for musculoskeletal issues.
• The target audience is Pharm D ninth-semester students.
• The lecturer is Dr. Shimaa Abdelgawad, a Pharmacognosy lecturer at Fayoum University.

Musculoskeletal System Definition

• Musculoskeletal health refers to the performance of the locomotor system.
• This system involves intact muscles, bones, joints, and connected tissues.

Musculoskeletal Disorders Symptoms

• Key symptoms include persistent pain.
• Limited mobility and dexterity.
• Reduced ability to work and participate in daily life.
• Pain in musculoskeletal structures is a common type of pain (not cancer-related).

Types of Musculoskeletal Disorders

• Joints: Osteoarthritis, rheumatoid arthritis, psoriatic arthritis, gout, spondylarthritis
• Bones: Osteoporosis, osteopenia, fragility fractures, traumatic fractures
• Muscles: Sarcopenia
• Multiple body areas: Regional pain (back, neck), widespread pain (fibromyalgia), inflammatory diseases (connective tissue diseases, vasculitis, systemic lupus erythematosus), amputation (due to disease or trauma)

Musculoskeletal Disorders Treatment

• Treatment plans vary based on the specific cause of musculoskeletal pain.
• Common treatments include:
  • Acupuncture
  • Therapeutic massage
  • Chiropractic adjustments
  • Occupational therapy
  • Splints
  • Steroid injections
  • Pain relievers (e.g., acetaminophen)
  • Herbal medicines

Arthritis Definition and Types

• Arthritis is inflammation of one or more joints.
• Types include:
  • Osteoarthritis
  • Rheumatoid arthritis
  • Gouty arthritis

Osteoarthritis

• A degenerative joint disease where protective cartilage wears down over time.
• Commonly affects: knees, hips, lower back, neck, small hand joints, and bases of thumb/big toe.
• Symptoms include: sharp/burning pain that increases with movement, pain from light pressure on joints, stiffness especially in the morning after rest.

Rheumatoid Arthritis

• A chronic inflammatory disorder, where the immune system mistakenly attacks the body's tissues.
• Commonly affects the joints of the hands, feet, wrists, elbows, knees, and ankles.
• Symptoms include joint pain, swelling, inflammation and stiffness.

Gouty Arthritis

• An inflammatory reaction caused by monosodium urate crystals depositing in joints. Caused by hyperuricemia (high levels of uric acid in the blood).
• Uric acid is a waste product produced when the body digests some foods.
• Often affects fingers, knees, ankles and big toes.

Drug Management of Arthritis

• Analgesics: Start with acetaminophen for mild or moderate osteoarthritic pain without inflammation. If no improvement try NSAIDs such as ibuprofen, naproxen, and diclofenac (or Celecoxib)
• Hydroxychloroquine: Approved for use in rheumatoid arthritis.
• Duloxetine: A selective serotonin-norepinephrine reuptake inhibitor.
• Corticosteroids: Effective in rheumatoid arthritis.
• Platelet-rich plasma (PRP): Intra-articular injection used to treat osteoarthritis, safer than many other choices.
• Sodium hyaluronate (visco-supplementation): An intra-articular injection, effective for knee osteoarthritis symptoms.
• Glucosamine and chondroitin sulfate: Used for symptomatic relief from osteoarthritis.
• Herbal supplements: Examples include avocado, feverfew, devil's claw, etc.

Natural Herbal Remedies for Arthritis

• Avocado: Contains phytosterols (β-sitosterol, campesterol, and stigmasterol). Its mechanism of actions includes anticatabolic properties (inhibiting cartilage degradation) and anabolic properties (promoting cartilage repair). Indications include osteoarthritis; dosage include fruits 0.5-2 daily or extracts/oils 300mg daily. Adverse reactions include caution when eaten in large amounts and possible drug interactions with warfarin (Coumadin)
• Devil's Claw: Iridoid glycosides (harpagoside and harpagide). Mechanism includes anti-inflammatory effects and analgesic properties; dosage include root tuber (up to 9g) or extract (1-3g) or harpagoside (50-100mg). Indications include osteoarthritis. Adverse reaction include headache, tinnitus (ringing in ears), anorexia (loss of appetite). Contraindications include caution with a history of ulcers and usage during pregnancy or lactation,
• Feverfew: Sesquiterpene lactones (Parthenolide). Analgesic and anti-inflammatory effects by inhibiting phospholipase, lipoxygenase, and cyclooxygenase enzymes to reduce prostaglandins, leukotrienes, and thromboxanes. Indications include rheumatoid arthritis, migraine; dosage include extracts 50-150mg daily. Adverse reaction includes allergy symptoms such as contact dermatitis. Contraindications include allergy to members of Asteraceae family
• Olibanum/Boswellia: Boswellic acid (triterpene) and essential oils. Inhibits 5-lipoxygenase (leukotrienes) and is an anti-inflammatory agent. Indications include osteoarthritis and rheumatoid arthritis; dosages include 300-400mg (containing 60% boswellic acids) 3 times daily or essential oils. Adverse reaction includes diarrhea, abdominal pain, and nausea. Contraindications include hypersensitivity, and caution during pregnancy and breastfeeding.
• White Willow Bark: Salicin. Anti-inflammatory/analgesic effects by inhibiting cyclooxygenase (COX-1) enzymes, thereby inhibiting prostaglandin synthesis. Indications include pain and mild rheumatic conditions; dosage include 120-240mg daily. Adverse reactions include upsets stomach, blood pressure increase, and allergies. Contraindications include bleeding issues, liver problems (diabetes, gout), and peptic ulcers
• Arnica Flower: Sesquiterpene lactones (helenalin, helenalin acetate, 11α,13-dihydro-helenalin). Anti-inflammatory by suppressing prostaglandin synthetase and reducing inflammatory cytokines (TNFα). Indications include topical treatment of muscular aches, joint pains, and arthritis (not for internal use); Dosage include topical application. Adverse reaction includes skin irritation, ingesting can cause gastroenteritis, heart issues, and death
• Turmeric (Roots): Curcuminoids (curcumin I). Anti-inflammatory and antioxidant effects inhibiting trypsin and hyaluronidase enzymes and scavenging oxygen radicals. Indications include pain, swelling, stiffness in rheumatoid arthritis; Dosage include dry powder up to 1.5g daily or standardized curcuminoid, adverse reaction includes stomach ulcers. Contraindications including gallbladder and bile duct problems, bleeding issues, hormone sensitive conditions (cancer), and pregnancy or breastfeeding.
• Ginger (Rhizome): Gingerols and shogaols, anti-inflammatory effects by inhibiting cyclooxygenase and lipoxygenase and reducing prostaglandins and leukotrienes. Indications include rheumatic and muscular disorders; Dosage include dried plant 0.5-3g daily or dried extract 250-500mg 3 times/day. Adverse reactions include heartburn, burping, diarrhea, and stomach upset. Contraindications include; bleeding disorders, gallstones, and shouldn't be combined with certain drugs.
• Butterbur (Leaves and Roots): Petasin. Inhibits leukotriene synthesis by inhibiting the enzyme lipoxygenase. Indications include analgesic relief of pain in rheumatoid conditions; Dosage include 50-150mg daily. Adverse reactions include heartburn, vomiting, dizziness, diarrhea, ulcers and liver/lungs damage
• Colchicine (Alkaloid): Proto-alkaloid or biological amine containing tropolone nucleus. Inhibits neutrophils (anti-inflammatory and immunosuppressive effects). Indications include prophylaxis and treatment of gout flares in adults; dosage include 0.6-1.2mg twice daily. Adverse reactions include gastrointestinal issues (diarrhea, nausea, cramping, pain, vomiting) and fatigue. Contraindications including liver and kidney issues

GLA (Gamma-linolenic acid)

• GLA is an all-cis-6,9,12 octadecatrienoic acid, found in evening primrose oil or borage oil. Mechanism includes reducing inflammation via inhibiting leukotrienes and 2-series prostaglandins and restoring inflammatory cytokine balance. Indications include rheumatoid arthritis. Dosage include 320-480mg daily. Adverse reactions include soft stools, diarrhea, belching and gas; contraindications include pregnancy, breastfeeding, and surgery.

This quiz explores various aspects of musculoskeletal disorders, including types of arthritis, pain management, and conditions associated with aging. Test your knowledge on inflammatory joint conditions, bone density issues, and related muscle disorders. Perfect for students and healthcare professionals alike!