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Upon completion of the chapter, the reader will be able to:

  1. Describe the pathophysiologic principles associated with tissue injury and inflammation.

  2. Identify the desired therapeutic goals and outcomes for a patient with musculoskeletal injury or pain.

  3. Identify the factors that guide selection of an analgesic or counterirritant for a particular patient.

  4. Recommend appropriate nonpharmacologic and pharmacologic therapy for a patient with musculoskeletal injury or pain.

  5. Design a patient education plan including nonpharmacologic therapy and preventative strategies.

  6. Develop a monitoring plan to assess treatment of a patient with musculoskeletal disorders.




  1. Image not available. The two primary goals of treating musculoskeletal disorders are to: (a) relieve pain and (b) maintain functionality.

  2. Image not available. 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.

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

  4. Image not available. There are two main approaches to pharmacologic intervention for pain relief: oral (systemic) and topical agents.

  5. Image not available. Localized pain may be treated effectively with local topical therapy, whereas generalized pain is best treated with systemic agents.

  6. Image not available. Acetaminophen is the drug of choice for mild-to-moderate regional musculoskeletal pain without inflammation.

  7. Image not available. 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.

  8. Image not available. Nonsteroidal anti-inflammatory drugs (NSAIDs) are preferred over acetaminophen in musculoskeletal disorders in which inflammation is the primary problem.

  9. Image not available. Patient education on proper use of counterirritants is essential to therapeutic success.

  10. Image not available. 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.




The musculoskeletal system consists of the muscles, bones, joints, tendons, and ligaments. Disorders related to the musculoskeletal system often are classified by etiology. Acute soft-tissue injuries include strains and sprains of muscles and ligaments. Repeated movements in sports, exercise, work, or activities of daily living can lead to repetitive strain injury, where cumulative damage occurs to the muscles, ligaments, or tendons.1,2 Although tendonitis and bursitis can arise from acute injury, more commonly these conditions occur as a result of chronic stress.2 Other forms of chronic musculo-skeletal pain, such as pain from rheumatoid arthritis (see Chap. 57) or osteoarthritis (see Chap. 58), are discussed elsewhere in this textbook.




Musculoskeletal disorders are commonly self-treated, so true estimates of the incidence of both acute and chronic injury are difficult to obtain. Musculoskeletal disorders are among the top 10 reasons for ambulatory care visits in the United States for all age groups.3 These disorders account for a large portion of medical care expenditures and are a leading cause of work ...

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