Competence of pain treatment goes beyond pharmacotherapy, combines it with i.a. pysiotherapy and kinesitherapy, which may precede and should be used after surgical procedures.
The art of combining various fields of medicine in order for fighting pain is useful when correct clinical diagnosis is stated. Pain treatment in musculoskeletal system diseases – part II presents ways of therapeutic procedures in painful shoulder syndrome, periarticular inflammations of elbow joint, bursitis of limbs, plantar aponeurositis, and other derivations of knee and hip pain.

Common afflictions are generalized pains in fibromyalgia, for which symmetrical arrangement of trigger points sensitive for pressure is characteristic. The treatment is mainly entailed with pricking trigger places and injections of local anesthetics. Furthermore, massages and warm compresses, which should be accompanied with passive and active exercises, are effective.

In the case of adhesive capsulitis of shoulder, which may lead to the muscular dystrophy and development of the so-called “frozen shoulder” , symptomatic treatment of the pain e.g., rubbing non-opioids painkillers, is advisable. After the establishing of a clinical diagnosis, in which a damage of a rotator cuff or the rupture of the sinew of biceps muscle are excluded, an appropriate kinesitherapy in which painful muscle is preheated, should be engaged. Active exercises which may sharpen the disease are contraindicated. Passive exercises of upper limb in which the limitation of movement are overcome are very effective. Additionally , the blockade of a suprascapular nerve and brachial plexus is employed which faster eliminates pains. Severe damages should be operated.

The conservative treatment of enthesopathies of an elbow joint are quite effective. These afflictions such as golfer’s elbow or tennis elbow abate idiopathically after the rest and facilitation of afflicted joint. Immobilization of a wrist in dorsiflexion and elbow in safe poition help it. Positive effects are also gained by iontophoresis with warming ointments and by shock wave procedures.

In enthesopathy of a foot, namely inflammation of aponeurosis plantaris, patients should use insertions and decrease their weight to relieve ailing part of a limb. Anti-inflammatory drugs and manual treatments are useful.

In metatarsalgias, which may be assumed when there is a pain of feet soles localised in III and IV or II and III of capitulum of cannon bone, one should relieve a foot and use comfortable footwear. If the treatment with the use of relieving insertions and steroid injections is not effective, the operational treatment is advisable.

Furthermore, considerable overloading may cause bursitis. Early therapeutic procedure with the use of NSAIDs therapy and physiotherapy, protect the patient against menacing complication of purulent bursitis. Then surgical drainage or complete excision of bursa is necessary.

The important issue in treatment are postoperative pains including pains after amputations. Specialised teams comprised of an orthopaedist, surgeon, rehabilitator and psychiatrist should take care of this.

Vital issue are back pains and chronic pains of unexplained aetiology. Their treatment is widely discussed. There are various directives regarding dealing with nonstop afflictions, and also scales due to which one can measure pain, e.g., graphical visual analogue scale, VAS. The persons in which the sources of pain were not founded and the demand for painkillers is increasing dramatically, are advised to visit specialised clinics of a pain treatment.

Author: Jerzy Bednarski

Want to know more about pain in musculoskeletal system? Watch on medtube.net: “Trochanteric Bursitis , hip bursitis- Everything You Need To Know – Dr. Nabil Ebraheim”.