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2017 HCHB_digital

Muscular Aches, Pains

Muscular Aches, Pains and Tightness Muscle aches and pains are typically caused by unaccustomed or overuse of a muscle, but can also be due to tension or stress, or as a result of injury from exercise or physically demanding work. Some conditions which affect the whole body, such as the flu (see Influenza), and other chronic disorders (such as fibromyalgia) can also cause muscle pain, but this tends to be a general type of pain which affects most of the body’s muscles, not just specific sets, as in the other causes listed above. Tight muscles usually develop over time and progressively worsen. Some people may be genetically more susceptible to them, or they may develop due to bad posture, electrolyte imbalances, incorrect sporting techniques, muscle fatigue, running style or poorly fitted shoes. Muscle tightness Muscle tightness can occur not only during or after exercise, but also after prolonged periods of inactivity. Cramps that occur during exercise are usually the result of muscle fatigue, low sodium, or low potassium. Their incidence can be reduced through proper hydration and nutrition before exercise and by drinking electrolyte replenishing drinks during activities that last longer than 60 minutes. Muscles are more likely to tighten following exercises that focus on eccentric contractions where a weight is lowered or slowed such as running downhill or the downward phase of a bicep curl. Gentle massage may ease the soreness and gradually increasing the intensity of a new exercise programme can help prevent it happening in the first place. Muscles that tighten as a result of inactivity are often due to poor posture. Long periods of time slouched at a desk can cause the chest muscles to shorten and the upper back muscles to lengthen and weaken. Good posture should be maintained throughout the day, strengthening exercises should target the small muscles of the back, and stretching exercises should concentrate on lengthening the chest muscles back to normal. Initial assessment Try to establish the cause and severity of your customer's muscle pain or tightness to help decide whether further investigation is necessary. Symptoms of muscle pain caused by unaccustomed or overuse of a muscle are typically confined to specific groups of muscles, or a matching pair of muscles. The pain usually peaks within 72 hours before subsiding. More severe muscle pain accompanied by swelling and restricted movement may indicate muscle, tendon, or ligament damage. Refer to a pharmacist (see also Strains and Sprains). Oral analgesics or topical rubs are the most common types of treatment for general muscle pain caused by overuse, in addition to stretching and strengthening exercises once the pain has gone. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, diabetes, is pregnant or breastfeeding) or take any medications (particularly medicine for high cholesterol). • Does the person have a serious loss of movement or mobility? • Is there an excessive range of movement in any joint (may suggest major ligament disruption)? • Did the injury swell immediately or become severely painful? • Is the person unable to weight bear, or is a fracture suspected? • Is the area swollen and/or warm to the touch now? • Is the person a child aged less than 12 or elderly? • Is the pain severe, getting worse or has it persisted despite treatment? • Has the pain lasted longer than three to four days? • Is the pain from a back injury? • Does the person have muscular pain with no specific cause? • Does the person have any allergies to medicines? Initial treatment of muscle aches and pain • For muscle pain due to an injury. »» Follow the RICED approach immediately (see Strains and Sprains). »» Take paracetamol, or a NSAID (eg, ibuprofen) if directed by a doctor. • For muscle aches due to overuse and fibromyalgia. »» Consider pain relief, topical heat rubs, massage therapy and stretching exercises. • For muscle pain due to an illness or infection, or for pain that has persisted for a long time. »» Speak to a pharmacist or doctor. Advice for customers • Low-impact exercises such as walking, cycling, and swimming can help restore proper muscle tone. Begin slowly and avoid high-impact activities initially. • Warm up and stretch before and after exercise. Page 108 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION TREATMENT OPTIONS Category Examples Comments Topical non-steroidal antiinflammatory agents (NSAIDs) Oral non-steroidal antiinflammatory agents (NSAIDs) Rubefacients (“heat” rubs) Agents that reduce bruising Simple analgesics Other topical products Muscle cramps Natural / herbal products / supplements [GENERAL SALE] eg, ibuprofen (Nurofen Topical Gel), diclofenac (Voltaren Emulgel*) [PHARMACY ONLY MEDICINE] eg, etofenamate (Rheumon Gel) [GENERAL SALE] eg, ibuprofen up to 25s (Advil, Nurofen), ibuprofen + paracetamol (Maxigesic* [16], Nuromol [12]) [PHARMACY ONLY MEDICINE] eg, diclofenac 12.5mg (Voltaren Rapid 12.5*), ibuprofen >25s (Advil, Nurofen), naproxen (Sonaflam), ibuprofen + paracetamol (Maxigesic [50, 100], Nuromol [24, 48]) [PHARMACIST ONLY MEDICINE] eg, diclofenac 25mg (Voltaren Rapid 25*), ibuprofen + codeine (Ibucode Plus, Nurofen Plus) paracetamol + codeine (Panadeine, Panadeine Extra) [GENERAL SALE] eg, Deep Heat Relief, Metsal Cream, Ice Gel, Tiger Balm Oil*, Tiger Balm Red Strength Ointment*, Tiger Balm White Regular Strength Ointment* [GENERAL SALE] eg, Arnica cream eg, mucopolysaccharide polysulfate (eg, Hirudoid) [GENERAL SALE] eg, paracetamol (Panadol Back + Neck Pain Relief) [PHARMACY ONLY MEDICINE] eg, Panadol Back + Neck Long Lasting [GENERAL SALE] eg, Anti-Flamme range, Badger Sore Muscle Rub, Dencorub Dual Action Cream, Flexagil Pain- Relief, Muscle oil, Percutane, Rehab Fix, USL Sport Linament, Zo-Rub eg, Omron HV-F128 TENS Device [GENERAL SALE] eg, Crampeze Night Cramps, Muscle Magnesium Capsaicin, camphor, willow bark, acupuncture, chiropractic manipulation, yoga, magnesium, zinc These treat the body’s inflammatory reaction to injury and reduce pain, but may delay tissue healing if used for longer than three days after the injury. Consult a doctor for further advice. Do not apply to broken skin or near the eyes or mucous membranes. Wash hands after applying. Do not use under sealed dressings. May, rarely, cause the same adverse effects as oral NSAIDs. Similar care and consideration before use is recommended. These treat the body’s inflammatory reaction to injury and reduce pain, but may delay tissue healing if used for longer than three days after the injury. Consult a doctor for further advice. Ibuprofen is the NSAID least likely to cause stomach irritation. NSAIDs may not be suitable for people on certain other medications or with some medical conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customers to stop taking if stomach upsets, increased bruising or prolonged bleeding occur. Avoid aspirin in children under 12 years. Warn customers that codeine is an addictive substance and should not be used for more than three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert for any customers who may be misusing codeine-containing preparations. See Reference Section, OTC Medicines – Precautions. Cause blood vessels in the treated area to open and create a sense of warmth, which masks the sensation of pain. These are usually effective at relieving localised muscle aches or pains. Do not apply to broken skin or near the eyes or mucous membranes. Wash hands after applying. Do not use under sealed dressings. Arnica cream contains a mixture of arnica flower and root and several essential oils to help relieve bruising. Hirudoid contains enzymes that help disperse excess fluid in swollen areas. Both creams also reduce swelling. Arnica also helps relieve pain. Effective at relieving pain but not anti-inflammatory so will not relieve swelling or inflammation in the area. Suitable for people with contraindications to NSAIDs. Rubbing these preparations onto the skin helps stimulate blood flow and create a feeling of warmth. Products contain ingredients such as arnica, cayenne pepper, chilli extracts, comfrey, ginger, menthol, and peppermint oil to relieve bruising and soothe sore muscles and stretched ligaments. TENS (Transcutaneous Electrical Nerve Stimulation) devices are predominantly used for nerverelated pain conditions. Products used for relief of cramps generally contain magnesium but may also include other ingredients such as rutin, citrus bioflavonoids and pyridoxine. May also help tired, aching and restless legs. Capsicum, camphor and willow bark have pain-relieving properties. Other types of therapies that aim to correct structural problems or relieve muscle tension can also be effective. Oral magnesium may be effective at relieving restless leg syndrome in some people. Oral zinc may help relieve muscle cramps in zinc-deficient people. Products with an asterisk have a detailed listing in the Muscular Aches & Pains section of OTC Products, starting on page 251. Page 109

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