Chronic Musculoskeletal Pain

Updated: January 5, 2023

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Background

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

etoricoxib

60

mg

Tablet

Oral

once a day



carisoprodol 

Indicated for Musculoskeletal Conditions:


250-350mg every 8 hours at bedtime. Do not exceed 2 to 3 weeks
In individuals who have a history of long-term usage, taper gradually (over 14 days) to prevent withdrawal symptoms, including sleeplessness, anxiety, or irritability



carisoprodol, aspirin, and codeine 

1 - 2

Tablets

Orally 

4 times a day

2 - 3

weeks



metaxalone 

800

mg

Orally 

every 6-8 hours



tizanidine 

Indicated for Muscle Spasticity:


Initial dose: 2mg orally thrice a day whenever necessary. Do not exceed three doses per day
Maintenance dose: Adjust dosage in increments of 2 to 4 mg daily, with a minimum interval of 1 to 4 days between dose adjustments, until the desired effect is achieved.
Do not exceed 36mg/day.
To gradually discontinue, reduce by 2-4 mg daily.



Dose Adjustments

Renal Impairment
CrCl <25 mL/min: Clearance decreased >50%
Creatinine Clearance Rate (CrCl) >25 mL/min: Not Studied; Caution Is Advised

capsaicin topical 

Apply on the site of pain 3-4 times daily for 3-4 weeks
After evaluation, if the efficacy is found to decrease, do not increase more than 4 applications each day



chlorzoxazone 

Administer 250 to 750mg orally thrice or four times a day



orphenadrine/aspirin/caffeine 

Indicated for relief from symptoms of mild-moderate pain that occurs due to musculoskeletal disorders in combination with physical therapy, rest, and other measures
0.5-1 tablet orally 3-4 times each day



mSM 

Take dose of 1000 to 3000 mg daily, divided
Take with food



metaxalone 

800 mg orally 3-4 times each day



loxoprofen 

Take a dose of 60 mg orally three times a day or 120 mg as a single daily dose



feprazone 

Apply 5% topical cream on to the affected area



piroxicam topical/capsaicin/menthol/methyl salicylate 

Apply a thin layer of gel topically every eight hours or every six hours a day



salicylamide 

5% as rubefacient preparations to be applied topically as directed



proglumetacin 

The suggested maximum dose is 600 mg daily



ibuproxam 

Apply 2 to 3 times a day for about 4 to 5 days



camphor/eucalyptus oil/menthol 

Apply topically on affected area 3-4 times a day



fenbufen 

Take 300 mg during morning hours & and 600 mg at sleep time, or take 450 mg two times a day



 

carisoprodol 

Indicated for Musculoskeletal Conditions:


<16 years: Safety and efficacy not established
>16 years: 250-350mg every 8 hours at bedtime. Do not exceed 2 to 3 weeks
In individuals who have a history of long-term usage, taper gradually (over 14 days) to prevent withdrawal symptoms, including sleeplessness, anxiety, or irritability



carisoprodol, aspirin, and codeine 


16 years or older
:

1 - 2

Tablets

Orally 

4 times a day

2 - 3

weeks



metaxalone 

<12 yrs: Safety and efficacy were not established
≥12 yrs: 800 mg orally every 6-8 hours



chlorzoxazone 

Administer 20 mg/kg orally divided thrice or four times a day or 600 mg/m² orally divided every thrice or four times a day



orphenadrine/aspirin/caffeine 

Indicated for relief from symptoms of mild-moderate pain that occurs due to musculoskeletal disorders in combination with physical therapy, rest, and other measures
0.5-1 tablet orally 3-4 times each day
Safety and efficacy are not seen in children less than 12 years



metaxalone 

Safety and efficacy are not seen in children less than 12 years
For more than 13 years, 800 mg orally 3-4 times each day



 

chlorzoxazone 

Administer 250 mg orally every 6 to 12 hours; increase the dosage to 750 mg orally whenever needed to every 6 to 8 hours



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References

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Chronic Musculoskeletal Pain

Updated : January 5, 2023

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