Over The Counter (OTC) Over The Counter (OTC) TREATMENT FOR MUSCLE TREATMENT FOR MUSCLE

SPRAIN & STRAINSSPRAIN & STRAINS

Presenter: Siti Noraisah Bt KifliPresenter: Siti Noraisah Bt Kifli

24 June 200924 June 2009

INTRODUCTIONINTRODUCTION minor injuries to the soft tissues and connective tissues minor injuries to the soft tissues and connective tissues

of the musculoskeletal system. of the musculoskeletal system.

Sprains a stretching or tearing Sprains a stretching or tearing of ligaments, the tough, fibrous bands of ligaments, the tough, fibrous bands of tissue that connect bones to one of tissue that connect bones to one another at a joint another at a joint

• Strains a stretching or tearing of Strains a stretching or tearing of muscle tissue, commonly called a pulled muscle tissue, commonly called a pulled muscle. muscle.

SYMPTOMSSYMPTOMS

SprainSprainMost common type:ankle sprainMost common type:ankle sprain Mild or minimal sprains:mild tenderness and Mild or minimal sprains:mild tenderness and some swellingsome swelling Moderate sprains: obvious swelling, Moderate sprains: obvious swelling, bruisingbruising, , significant tenderness, and difficulty walking. significant tenderness, and difficulty walking. Severe sprains: walking impossible and Severe sprains: walking impossible and produce marked swelling, internal bleeding produce marked swelling, internal bleeding and joint instability.and joint instability.Strains Strains muscle soreness, muscle spasm, pain, and possibly muscle soreness, muscle spasm, pain, and possibly swelling or warmth over the involved muscle.swelling or warmth over the involved muscle.

OTC PRODUCTS FOR TREATMENTOTC PRODUCTS FOR TREATMENT

ParacetamolParacetamolNSAIDSNSAIDSNutritional supplementsNutritional supplementsMiscellaneousMiscellaneous

ParacetamolParacetamol

AnalgesicAnalgesic Mild t0 moderate painMild t0 moderate pain

500-1000mg every 4-6 hours, not exceed 4g/day500-1000mg every 4-6 hours, not exceed 4g/day

If the recommended amount does not relieve the If the recommended amount does not relieve the pain, try different medicationpain, try different medication

→→excessive amounts can cause liver damageexcessive amounts can cause liver damage

NSAIDsNSAIDs

AspirinAspirin

Analgesic & anti-inflammatoryAnalgesic & anti-inflammatory Mild t0 moderate painMild t0 moderate pain

300 - 900 mg every 4 - 6 hrs as required; Max 4 g daily300 - 900 mg every 4 - 6 hrs as required; Max 4 g daily

Take with food to prevent stomach upsetTake with food to prevent stomach upset

NSAIDs NSAIDs cont..cont..

Analgesics & anti-inflammatoryAnalgesics & anti-inflammatory

IbuprofenIbuprofen (tablet/gel) (tablet/gel) → → 200-400 mg TDS, max 2.4 g daily200-400 mg TDS, max 2.4 g daily Diclofenac sodiumDiclofenac sodium (tablet/gel for LA) (tablet/gel for LA) → →75-150 mg daily in 2-3 divided doses75-150 mg daily in 2-3 divided doses Mefenemic acidMefenemic acid (tablet/capsule) (tablet/capsule) →→ 250-500 mg TDS250-500 mg TDS NaproxenNaproxen (tablet) (tablet) → → initial 500 mg, then 250 mg 6-8 hrly, max 1250 mg/dayinitial 500 mg, then 250 mg 6-8 hrly, max 1250 mg/day KetoprofenKetoprofen (tablet/gel/plaster,kenhancer (tablet/gel/plaster,kenhancer®®)) → → 150-200 mg daily in 3-4 divided doses150-200 mg daily in 3-4 divided doses

NSAIDs NSAIDs cont..cont..

Not recommended for 1Not recommended for 1stst line tx line tx →→affect long term healingaffect long term healing → →blunt the healing process by the anti-inflammatory blunt the healing process by the anti-inflammatory

effecteffect

Some research has shown NSAIDs can lead to an earlier Some research has shown NSAIDs can lead to an earlier return to activityreturn to activity

→ →increase risk of recurrenceincrease risk of recurrence → →one of the roles of inflammation & pain in healing is to one of the roles of inflammation & pain in healing is to

limit movement to prevent further damagelimit movement to prevent further damage

Nutritional supplementsNutritional supplements Calcium + magnesiumCalcium + magnesium →→help repair connective tissuehelp repair connective tissue → →500-1000 mg Ca +250-500 mg Mg 1-2 500-1000 mg Ca +250-500 mg Mg 1-2 dailydaily

Vitamin C + bioflavonoidsVitamin C + bioflavonoids → →required for tissue repair & fight inflammationrequired for tissue repair & fight inflammation → →bioflavonoids improves body’s ability to absord & hold on to vit bioflavonoids improves body’s ability to absord & hold on to vit

CC → →1000mg 4-5 times daily for 1week, then reduce to 500-1000mg 1000mg 4-5 times daily for 1week, then reduce to 500-1000mg

2-3 times daily till healing is complete2-3 times daily till healing is complete

ZincZinc → →helps the healing processhelps the healing process → →25 mg BD for 2 weeks25 mg BD for 2 weeks

MiscellaneousMiscellaneous

Methyl salicylate oitment/cream/patchMethyl salicylate oitment/cream/patch

→→analgesicanalgesic

→ →apply to affected area BD-TDSapply to affected area BD-TDS

→ →formulation contentformulation content patch (SALONPASpatch (SALONPAS®®):):Methyl salicylate, glycol Methyl salicylate, glycol

salicylate,menthol, thymol, camphor, tocopherol acetate salicylate,menthol, thymol, camphor, tocopherol acetate

cream (THERMORUBcream (THERMORUB®®):):methyl salicylate, eucalyptus oil, methyl salicylate, eucalyptus oil, turpentine oilturpentine oil

PRICEPRICE

Appropriate tx of sprains & strains for the 1Appropriate tx of sprains & strains for the 1stst 48 hrs of 48 hrs of injuryinjury

P: ProtectionP: Protection

R: RestR: Rest

I: IceI: Ice

C: CompressionC: Compression

E: ElevationE: Elevation

HARM (heat, alcohol, running exsercise, massage) HARM (heat, alcohol, running exsercise, massage) should be avoidedshould be avoided

REFERENCESREFERENCES

Rhiannonn Braund 2006.Should NSAIDs be routinely used in the Rhiannonn Braund 2006.Should NSAIDs be routinely used in the treatment of sprains and strains?. treatment of sprains and strains?. The Pharmaceutical JournalThe Pharmaceutical Journal. 276: . 276: 655-656655-656

Zand, J., Spreen, A., N., & Lavelle, J., Zand, J., Spreen, A., N., & Lavelle, J., B.Smart.Medicine for B.Smart.Medicine for Healthier Living: muscle sprain, strain and painHealthier Living: muscle sprain, strain and pain. 429-431. 429-431

Ministry of Health MalaysiaMinistry of Health Malaysia. Drug Formulary 2008.. Drug Formulary 2008. Understanding Sprains and Strains: Information, Symptoms, Understanding Sprains and Strains: Information, Symptoms,

Treatment, and Prevention Treatment, and Prevention http://www.hipusa.com/webmd/encyclopedia/sprains_strains/http://www.hipusa.com/webmd/encyclopedia/sprains_strains/ Sprains and strainsSprains and strains http://www.arrowclaims.com/2007/citations/sprain_strainhttp://www.arrowclaims.com/2007/citations/sprain_strain.. www.mimsonline.comwww.mimsonline.com