A PROSPECTIVE STUDY OF SAFETY AND EFFICACY OF ORAL ANALGESICS IN THE MANAGEMENT OF ACUTE MUSCULOSKELETAL PAIN

M. TEJASWI SAI PRIYA; S. SHARON SONIA; PADMA SRAVANI SAGI

doi:10.22159/ijcpr.2024v16i3.4083

Authors

M. TEJASWI SAI PRIYA Department of Pharmacology, Government Medical College, Ananthapuramu-510051, Andhra Pradesh, India
S. SHARON SONIA Department of Pharmacology, Government Medical College, Ananthapuramu-510051, Andhra Pradesh, India
PADMA SRAVANI SAGI Department of Pharmacology, Government Medical College, Ananthapuramu-510051, Andhra Pradesh, India

DOI:

https://doi.org/10.22159/ijcpr.2024v16i3.4083

Keywords:

Acute musculoskeletal pain, Oral analgesics, Safety, Efficacy, Visual analogue scale, Verbal rating scale

Abstract

Objective: Musculoskeletal pain is a significant health problem in adolescents and challenging condition for clinicians and physicians. Acute musculoskeletal pain is sudden and severe which lasts less than 12 w. This study was aimed to assess the efficacy safety of oral analgesics in the management of the condition.

Methods: A Prospective study on oral analgesics prescribed routinely for this pain was conducted among 100 patients who attended OPD, at Area Hospital, Dharmavaram. 25 patients were included in each group; group a were given tramadol 100 mgOD, group B-paracetmol 500 mgBD, Group C-ibuprofen 200 mgBD and group D-dicolfenac 50 mgBD. The severity of pain assessed by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). The data was analysed by using SPSS-21version.

Results: Number of subjects included in the analysis 100 who were divided equally into 4 groups. The improvement in pain relief as follows-Group a given tramadol 100 mg showed pain relief of 80%VAS and 84%VRS. Group b given paracetmol 500 mgBD-40% by VAS and VRS. Group c given ibuprofen 200 mgBD showed 60% by VAS and 68% by VRS. GROUP D given diclofenac 50 mgBD showed better improvement of pain relief i. e 88% by VAS and 96% by VRS, yet the p-value is 0.001, showing difference statistically significant.

Conclusion: Among all 4 groups, Tramadol and Diclofenac showed better response (80% and 84%;88 and 96% respectively). Diclofenac is non-opioid. Hence, considering safety and improvement in pain relief in acute musculoskeletal Pain, Oral Diclofenac is preferred analgesic of choice over oral tramadol, an opioid with an adverse drug reaction profile that includes rising BP, causing seizure and addiction liability.

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References

WHO. Musculoskeletal conditions; 2019. World Health Organization. Available from: https://www.who.int/news-room/factsheets/detail/musculoskeletal-conditions [Last accessed on 17 Jul 2020]

El-Tallawy SN, Nalamasu R, Salem GI, LeQuang JA, Pergolizzi JV, Christo PJ. Management of musculoskeletal pain: an update with emphasis on chronic musculoskeletal pain. Pain Ther. 2021 Jun;10(1):181-209. doi: 10.1007/s40122-021-00235-2, PMID 33575952.

Blyth FM, Briggs AM, Schneider CH, Hoy DG, March LM. The global burden of musculoskeletal pain-where to from here? Am J Public Health. 2019 Jan;109(1):35-40. doi: 10.2105/AJPH.2018.304747, PMID 30495997, PMCID PMC6301413.

Pain IA. Terminology. International Association for the Study of Pain (IASP). Available online: https://www.iasp-pain.org/resources/terminology/#pain [Last accessed on 26 Oct 2021]

Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence. PLOS ONE. 2017;12(6):e0178621. doi: 10.1371/journal.pone.0178621, PMID 28640822.

Khonsary SA. Goodman and gilman’s the pharmacological basis of therapeutics. Surgical Neurology International. 14th ed.; 2023. doi: 10.25259/SNI_184_2023, PMCID PMC10070253.

Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR. Validation of digital visual analog scale pain scoring with a traditional paper-based visual analog scale in adults. J Am Acad Orthop Surg Glob Res Rev. 2018 Mar 23;2(3):e088. doi: 10.5435/JAAOSGlobal-D-17-00088, PMID 30211382.

Mutebi A, Slack M, Warholak TL, Hudgens S, Coons SJ. Interpretation of verbal descriptors for response options commonly used in verbal rating scales in patient-reported outcome instruments. Qual Life Res. 2016 Dec;25(12):3181-9. doi: 10.1007/s11136-016-1333-3, PMID 27294436.

Bijur PE, Friedman BW, Irizarry E, Chang AK, Gallagher EJ. A randomized trial comparing the efficacy of five oral analgesics for treatment of acute musculoskeletal extremity pain in the emergency department. Ann Emerg Med. 2021 Mar;77(3):345-56. doi: 10.1016/j.annemergmed.2020.10.004, PMID 33358232.

Nikose S, Khan S, Gudhe M, Patil B, Pradeep K. Singh efficacy of diclofenac versus combination of ibuprofen and paracetamol, in acute low back pain with sciatica. EJPMR. 2016;3(12):487-91.

Moore RA, Derry S, Wiffen PJ, Straube S, Aldington DJ. Overview review: comparative efficacy of oral ibuprofen and paracetamol (acetaminophen) across acute and chronic pain conditions. Eur J Pain. 2015 Oct;19(9):1213-23. doi: 10.1002/ejp.649, PMID 25530283.

Aronson J. Meyler’s side effects of drugs: the international encyclopedia of adverse drug reactions and interactions. 15th ed. Amsterdam, Boston: Elsevier; 2006.

Man S, Woo W, Lam P, Rainer T. Feasibility study comparing oral paracetamol and oral non-steroidal anti-inflammatory drugs for treating pain after musculoskeletal injury: a randomised, double blind, controlled trial. HK J Emerg Med. 2004;11(2):78-84. doi: 10.1177/102490790401100203.

Kurita GP, Sjøgren P, Juel K, Højsted J, Ekholm O. The burden of chronic pain: a cross-sectional survey focussing on diseases, immigration, and opioid use. Pain. 2012;153(12):2332-8. doi: 10.1016/j.pain.2012.07.023, PMID 22959600.

Eric E, Bondarsky MD, Anna T, Domingo BS, Nicholas M, Matuza BS, Maria B, Taylor RN, Henry C, Thode Jr, Adam J, Singer MD. Ibuprofen vs acetaminophen vs their combination in the relief of musculoskeletal pain in the ED: a randomized, controlled trial. The American Journal of Emergency Medicine. 2023;31(9):1357-60. doi: 10.1016/j. ajem.2013.06.007.

Subedi M, Bajaj S, Kumar MS, Yc M. An overview of tramadol and its usage in pain management and future perspective. Biomed Pharmacother. 2019;111:443-51. doi: 10.1016/j.biopha.2018.12.085, PMID 30594783.

Auad A, Cadena L, Garzon LA. Efficacy and safety of the fixed combination diclofenac/tramadol in acute pain: randomized clinical trial phase III, double-blind, controlled Ibero Americana. Rev Pain 2009;41:323.

Kumar Shukla A, Kumar Srivastav A. Comparative study of tramadol and diclofenac as analgesic for postoperative pain. Int J Med Res Rev. 2015;3(11):1311-6. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/412 [Last accessed on 29 Apr 2024]