Key concepts

The two primary goals of treatment of musculoskeletal disorders are to: (a) relieve pain, and (b) maintain functionality.

'O The cornerstone of nonpharmacologic therapy for acute injury in the first 48 to 72 hours is known by the acronym RICE: rest, ice, compression, and elevation.

Heat should not be applied during the acute injury phase (the first 48 hours) because it promotes swelling and inflammation.

There are two main approaches to pharmacologic intervention for pain relief: oral (systemic) and topical agents.

Localized pain may be treated effectively with local topical therapy, whereas generalized pain is best treated with systemic agents.

Acetaminophen is the drug of choice for mild-to-moderate regional musculo-skeletal pain without inflammation.

Aspirin is not more effective than acetaminophen, and it is not recommended for treatment of acute musculoskeletal pain because its adverse effects may be more common and severe.

® Nonsteroidal anti-inflammatory drugs (NSAIDs) are preferred over acetaminophen in musculoskeletal disorders where inflammation is evident.

Patient education on proper use of counterirritants is essential to therapeutic success.

Patients using capsaicin should be advised to apply it regularly and consistently three to four times daily and that full effect may take 2 to 3 weeks or longer.

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