General Advice

Many patients suffer chronic musculoskeletal pain. This may result from injury but most commonly it relates to underlying degeneration (osteoarthritis). Degeneration is due to cell aging. The cells producing cartilage and synovial fluid (joint fluid) become less efficient. As a result the joint surface becomes less smooth and there is less lubricant. This can lead to inflammation and pain.  In most people degeneration is a slow process, so most people live with this type of pain for many years, even decades.

Learning how to manage and reduce pain while preserving quality of life is the key to living with this disease. Here are a few basic things to do that really help.

Use things to help with the pain other than medications

• Hot packs – not the wheat bag type, Breville (no we don’t have shares in the company – try Retravision or the Good Guys) make an excellent heating pad, (about $50) which you can buy at Myers, DJs or K mart.
• Cool packs – wrap ice or ice packs in a thin towel and place on the affected area.
• Other things that help – transcutaneous electrical stimulation (need to be prescribed by a physiotherapist), massage, stretching, exercise (see my exercise handout), relaxation, distraction and meditation.   

Use the simplest, least damaging medications first

• Paracetamol – the simplest and most effective drug, use it! If you don’t have any problems with your liver take two tablets every six to eight hours regardless of whether you have pain or not. There are no known long term side effects.
• Non Steroid Anti Inflammatory Medications – e.g. Brufen, Feldene, Celebrex, Mobic, Indocid. These drugs shouldn’t be used for periods of longer than two weeks. Longer use can lead to problems such as stomach ulcers, heart disease and stroke. If you are using these long term then look to talk about it with your specialist and your general practitioner. These should ideally be replaced with paracetamol.
• Chondroitin Sulphate / Glucosamine – These have shown to be useful in patients with osteoarthritis and can be used safely.
• Opioids – these include medications such as Oxycontin, Endone, MS Contin, Panadiene Forte, Kapanol. They should be avoided in patients with non cancer pain. If used they should be used in low dose.