Musculoskeletal conditions can cause tremendous discomfort and severely affect the quality of life of sufferers. They also account for a significant proportion of direct healthcare costs. To manage these patients effectively, a comprehensive set of services should be available, including pain interventions, psychological interventions, and functional restoration. The provision of these diverse services in a single practice or unit has the potential to overcome the significant risks evident in the sequential referral process. This is a possible direction for the future health management paradigm. This practice parameter shows how a clinic has built up a comprehensive set of services over time and used the evidence base to inform their choice of interventions, locally available services, and diagnostics. Over the next few years, it is anticipated that patient outcomes will reach internationally published levels of acceptability.
In this series, we have defined the content of the Orthopaedic and Pain Practice, some of its processes, characteristics of patients that attend, and the current makeup of chronic pain presentations. Patients who visit the Orthopaedic and Pain Practice present with multi-joint mild to moderate irreversible degenerative musculoskeletal conditions. The clinical staff are used to working with these non-traumatized conditions, and the concept of a modern biopsychosocial model of care delivery is well understood. There is also a key focus on reducing the cosmetic and psychological impact of anatomically exaggerated sites for these patient groups, such as varus knee. The modern clinical model also includes an understanding by patients that the grief pathway is as important as examinations and diagnostic imaging. The delivery of modern management approaches for diagnosing and treating chronic, multi-joint presentations of musculoskeletal conditions is also well established. All current literature and treatment options cited are also in clinical use in both public and private practice settings.
Understanding Musculoskeletal Conditions
Musculoskeletal conditions are one of the top causes of disabilities in many countries, with an additional impact on workforce exit. It is estimated that 1 in 4 Singaporeans aged 30 years and above is suffering from osteoarthritis of the knee or hip. The musculoskeletal system is composed of the connective tissues of the body that allow for structure, form, stability, and locomotion. This includes the bones as girders, the muscles as motors, the joints as rotating wheels, and the tendons and ligaments as belts and pulleys to ensure connectivity and coordinated movements. When diseased or injured, it can cause pain and disability, leading to the inability to conduct activities at home and work. This can usually lead to a short-term and sometimes long-term absence from work. The musculoskeletal system plays a significant role in mobility and activities of daily living. Keeping the system in optimal condition is thus crucial. However, it is also the system of the body that often comes under the most stress with daily physical activity and exposure to trauma. While some conditions such as arthritis can happen with age, others can occur with injury or secondary to an active lifestyle. Musculoskeletal injuries such as ankle sprains, meniscus and ligament tears in the knee, and rotator cuff tears in the shoulder are just some of the sports injuries that can happen. High trauma injuries, such as fractures, can also be seen. Arthritis or osteoarthritis would be a common condition seen with age. For example, osteoporosis that weakens the bone can also be seen as individuals get older. Aside from the diminishing quality of life, it also places stress on healthcare, caregivers, and the government. Alleviating this burden on society involves some form of early intervention, ranging from treating these conditions to managing them. Retrospectively, education forms an integral part in the prevention of these musculoskeletal conditions.
Overview of Musculoskeletal System
The musculoskeletal system encompasses bones, muscles, and connective tissues. The skeletal system provides structure to the body by supporting the muscles attached to it and acts as levers for movement. Muscles, ligaments, tendons, joint capsules, and the nervous system are composed of soft tissues that allow bones to articulate for functional activities. The connective tissues bridge bones to bones, muscles to bones, and muscles to muscles. Ligaments serve as passive wrist joint stabilizers connecting bones at the joints, while tendons connect the muscles to bones for smooth wrist joint motion. The interconnected musculoskeletal system maintains equilibrium by working in balance. The axial skeleton, consisting of the bones of the head and trunk, provides protective functions for the body’s organs. The appendicular skeleton, including the bones of the upper and lower extremities, supports the strength to manipulate and hold items, travel or navigate different areas, and handle forces occurring through the lower extremities after landing from a jump. Skeletal muscles perform physical work in the musculoskeletal system and enable a wide variety of human body postures and functional activities. An understanding of the basics of musculoskeletal anatomy and physiology allows for the detection of the origin of different musculoskeletal diseases and disorders. The study of mechanics in biology is referred to as biomechanics. Individuals and healthcare professionals alike benefit from an appreciation of the musculoskeletal system. As a result, an overview of the system serves as a foundation for a more in-depth discussion of orthopedic and pain conditions.
Treatment of Lower Back Pain
Results from studies have shown that the origin of pain can be from varying anatomical regions in patients with lower back pain; the disc, the facet joint, and the sacroiliac joint all play important roles in generating back pain. Consequently, a high proportion of patients with back pain may have more than one source of pain, and patients with leg pain may also have simultaneous sources of leg pain. Our aim is to maximize neurological improvement, if any, relieve pain, and facilitate rehabilitation. Often, it is critical that the treating physician communicates with the patient at the end of the treatment and discusses realistic expectations, dos and don’ts, and how to avoid recurrence. Since the lower back, unlike other parts of our body, needs to be in movement and strong, we put all our focus on preventing recurrence. Recurrent back pain has higher long-term morbidity than purely improving pain in the initial situation. Many women seek lower back pain period relief during their menstrual cycle.
Period Relief for Musculoskeletal Conditions
Patients with chronic musculoskeletal conditions often need strategies for periodic relief from their condition. Pain is a subjective experience and is what the patient says it is; it is influenced by many physiological, psychological, and environmental factors. The mechanisms that regulate the way people perceive pain are straightforward enough. Peripheral activations, inhibitory and excitatory modulation in the spine, processing in the brainstem, and thalamic gating, before interpretation in the cortex, means there are plenty of points to alleviate symptoms. An improvement at one level is generally enough to improve function and hence quality of life. The suggested way to relieve pain is by using techniques that work at different levels. Together, they should provide a good, comprehensive effect to relieve pain. It is important to follow up with patients and monitor this response and subsequently alter treatments if necessary to get the best effects. Lower back pain treatment muscle relaxants can help alleviate severe discomfort.
Pharmacological interventions can provide quick and effective pain relief. Non-pharmacological interventions are usually not effective for providing quick pain relief but aim to provide long-term pain relief. A succession of attempts needs to be made to help a patient control their pain. Failing one technique does not preclude success with another. Failure to relieve the emotional responses or coping mechanisms may make success with other methods less likely. Due to this, we believe that a comprehensive approach to chronic musculoskeletal pain will be most likely to yield positively sustained results. A frequently understated element of care is the non-sought treatment of lifestyle. Non-sought treatment includes advice on exercise, activity, weight loss, and drug and alcohol consumption, among other things. Taken together, current evidence would strongly suggest that for the majority of patients presenting with chronic musculoskeletal pain, the best available management for optimal outcomes involves a combination of therapies.
Muscle Relaxants in Treating Musculoskeletal Conditions
Muscles are one of the soft tissues surrounding and supporting our skeleton and, in the context of musculoskeletal conditions, play a significant role in the development and sustaining of pain and dysfunction. Muscle spasm is essentially constant, involuntary, and excessive muscle contraction present in either the affected area or the supporting muscles. Its presence is a turn in the circle of cause and effect wherein the presence of pain encourages muscle spasm and muscle spasm increases pain. Thus, breaking this vicious cycle is the impetus in therapy. Effective lower back pain weight lifting treatment includes proper form and strength training exercises.
The tension in muscles, particularly in the paravertebral and larger portal muscles, is thought to be responsible for the lower back pain experienced by the large majority of us or to result in the exacerbation of an existing problem. Hence, muscle relaxants form one part of the therapy for managing lower back pain and other related musculoskeletal conditions. Typical conditions where the prescription of muscle relaxants may be considered include those involving muscle tension and spasm, such as lower back pain, neck pain, and muscle strains; fibromyalgia, spasticity, and temporomandibular joint syndrome.
In various conditions and gait mechanisms, one muscle relaxant may be preferred over the other or selected based on the concomitant pain condition. For example, baclofen, diazepam, and tizanidine are considered more suitable than dantrolene in patients with upper motor neuron lesions who present with pain secondary to muscle spasm. Similarly, spasticity with associated negative etiology may have a better response to baclofen. A multidisciplinary approach integrating muscle relaxant therapy with a physical therapy program is necessary for overall patient wellness and enhanced outcomes. Patient education is also necessary to titrate expectations and explain usage guidelines. No drug is 100% safe, and muscle relaxants may cause drowsiness and other significant side effects. Hence, the influence of individual variation, age, occupation, and dose on side effects should be addressed prior to prescription. Patient evaluation, education, and personalized decision-making for medication use are the keys to successful management of musculoskeletal problems.
Innovations and Advancements in Musculoskeletal Care
The musculoskeletal environment is an exciting field of growth in medicine. We continue to learn more about the different areas of the body, the various tissues within, and the intricate relationships among the muscles, ligaments, tendons, nerves, bones, and the spine. It is from such research that the most cutting-edge ways of performing surgery and guiding intraoperative processes have emerged. Many more are still being researched and are currently part of ongoing clinical trials, but the pathways from initial thinking to established therapy to standard clinical practice constantly evolve. It is fitting that the Orthopaedic and Pain Practice continues to stay on top, if not proceed forward in the rapidly and creatively advancing frontier of orthopaedics, pain, spine, and sports. As a forward-thinking practice, we advocate the progressive integration of these innovations and advancements.
A wide range of minimally invasive techniques are available that are supported by various types of evidence. Regenerative medicine, using the body’s own cells, is making headlines and has shown promise in transforming the landscape of management in orthopaedics. Biologic materials and structures are reported to reduce pain and improve function in simple procedures with a lower risk profile. Even in surgery, there is an emergence of computer and robot-guided procedures in the intraoperative systems, insertion frequencies, and all through feedback-driven robotics, increasing both safety and efficacy given patient-specific optimal surgical care. It goes without saying that with any innovation in healthcare and life in general, technology must keep up with expectations for patients. For us, this involves the integration of real-time measurement, telemedicine, and even mobile apps into our approach to provide you with the services we know you want. It is through these and all mentioned above that we truly believe the optimal outcome, both short-term and long-term, for you will be at its best.