Musculoskeletal Injuries and Disorders Drug Chart PDF

Chapter: Musculoskeletal Injuries and Disorders (21st edition) Treatment Strategy Compression...

Chapter: Musculoskeletal Injuries and Disorders (21st edition) Treatment Strategy Compression or Topical Systemic Elimination Rest Ice Immobilization Elevation Type analgesics analgesics of cause Stretching Heat (RICE) Other nonpharmacologic strategies Myalgia X X X X Tendonitis X X X X Bursitis X X X Sprain X X X X X Strain X X X X X X X Continuous exercise (light-moderate Osteoarthritis1 X activity); weight loss Overexertion X Low back pain – Acute X First line treatment: Exercise, rehab, Low back pain – Chronic2 acupuncture, psychological therapy, tai chi, yoga, motor control exercise, etc. 1 = Topical NSAID or systemic NSAIDs (potentially with proton pump inhibitor) preferred due to inflammatory properties; 2 = Systemic NSAIDs can be trialed (second line), but patient may need referred to specialist Nonpharmacologic Treatment Options Prevention Transcutaneous electrical nerve stimulation (TENS) therapy  Warm up and stretch before physical activity  Medical device for relief of pain associated with sore, aching muscles; joint pain; or chronic intractable pain  Maintain hydration (water, sports drinks, or water with electrolytes)  MOA: alteration of pain transmission and an increase in the production of natural endorphins  Use for 15-30 minutes up to three times per day  Do not place electrodes on the throat, chest, or head, or over the carotid arteries or on open wounds, rashes, inflamed skin, cancerous lesions, areas of skin with altered sensation, or areas treated with topical analgesics  Do not use if the patient has an attached medical device (e.g. pacemaker, defibrillator), pregnant women, or the pediatric population Heat therapy RICE  May help non-inflammatory pain and stiffness  Rest the injured area and continue until pain is reduced (generally 1-2 days). Slings, splints, or crutches can be used if necessary.  Can use warm wet compress, heating pad, or hot water bottle, or heat  As soon as possible, apply ice to the injured area in 15-20 minute increments, at least 3 to 4 times a day. Continue the ice-pack therapy until swelling generating adhesive or wrap products subsides (usually 1-3 days).  Do not place directly on skin as it can cause blistering or burning o Do not apply directly on skin as it can cause blistering or burning  Apply for 15-20 minutes 3-4 times a day  Apply compression to the injured are with an elastic support or an elasticized bandage as follows:  Do not apply to inflamed areas o Choose the right size ideally designed specifically for that location)  Do not use with topical analgesic or over broken skin o Soak bandage in water to aid transfer of cold (if ice is being applied)  Do not use during sleep o Wrap the injured area by overlapping the previous layer of bandage by approximately one-third to one-half its width.  If >55 years, only use over a towel or layer of clothing o Wrap the point most distal from the injury (e.g., if the ankle is injured, begin wrapping just above the toes)  Adverse effects are rare but may include skin irritation or burns o Decrease the tightness of the bandage as you continue to wrap. If too tight or uncomfortable or causing cold toes or swollen fingers, remove (remove immediately if pain, discomfort, itching, or burning occurs) bandage and re-wrap. o After removal, wash bandage in lukewarm, soapy water; do not scrub it. Rinse the bandage thoroughly and allow to air dry on a flat surface. o Roll up the bandage to prevent wrinkles, and store in a cool, dry place. Do not iron the bandage to remove wrinkles.  Elevate the limb or body part with the injured area at or above the level of the heart to decrease swelling and relieve pain.